Residual neuromuscular block is a risk factor for postoperative pulmonary complications A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium

Berg, H.; Viby‐Mogensen, J.; Roed, J; Mortensen, Christian; Engbaek, J; Skovgaard, L. T.; Krintel, J. J.

doi:10.1111/j.1399-6576.1997.tb04851.x

Cited by 604 publications

(276 citation statements)

References 18 publications

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“…In general, pulmonary complications were three times higher among patients receiving a longacting neuromuscular blocker than among those receiving shorter-acting relaxants. 62 The rate of postoperative pulmonary complications may be further increased in elderly patients who are overly narcotized, as hypoventilation leading to respiratory acidosis may potentiate the effects of residual neuromuscular blockade. To avoid these problems in the older patient, shorter acting neuromuscular blocking agents should be selected and the adequacy of reversal of neuromuscular block should be tested before tracheal extubation.…”

Section: Anesthesia Related Factorsmentioning

confidence: 99%

Review article: Age related alterations in respiratory function — anesthetic considerations

Šprung

Gajic

Warner

2006

Can J Anesth/J Can Anesth

145

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Purpose: This review examines the effect of aging on pulmonary reserve. Special emphasis is placed on how anesthetic and surgical factors may impose substantial stresses on the respiratory system of elderly patients, leading to increased risk for postoperative pulmonary complications including respiratory failure.Source: A MEDLINE-based English-language literature search was undertaken for the period 1966-2006, and an EMBASE search covered the overlapping period 1988-2006. Selected articles were limited to those applying to elderly subjects/patients. Principal findings:Age-related loss of the lung static recoil forces, stiffening of the chest wall and diminished alveolar surface area lead to a decrease in vital capacity, an increase in residual volume, decrease in expiratory flows and increased ventilation-perfusion heterogeneity. Respiratory muscle strength consistently declines with age further increasing the work of breathing. While gas exchange may be well preserved at rest and during exertion, pulmonary reserve is diminished, and under conditions of positive fluid balance, positioning for surgery, and increased metabolic demand, postoperative respiratory failure can occur. Increased sensitivity to respiratory depressants and muscle weakness pose additional risks for the development of postoperative respiratory complications in elderly patients. Regional anesthetic techniques provide for superior postoperative analgesia, without necessarily altering the frequency of postoperative pulmonary complications in the older surgical population. Conclusion:Alterations in respiratory physiology associated with aging must be appreciated to anticipate and minimize potential complications associated with surgery and anesthesia in the elderly. Individualized care to optimize preoperative cardiorespiratory function, minimize intraoperative respiratory pertubations, and to gently restore postoperative pulmonary function are essential anesthetic goals for elderly patients who require surgery. Objectif

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Section: Anesthesia Related Factorsmentioning

confidence: 99%

Review article: Age related alterations in respiratory function — anesthetic considerations

Šprung

Gajic

Warner

2006

Can J Anesth/J Can Anesth

145

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“…However, the extended effects of neuromuscular blocking drugs may lead to postoperative complications and ⁄ or a risk of residual neuromuscular paralysis in the post-anaesthesia care unit, which may contribute to morbidity in patients recovering from surgery [1,2]. Rapid and reliable reversal of neuromuscular blockade at the end of surgery is therefore desirable to enhance patient safety and comfort, and this may potentially decrease the time spent in the operating room and post-anaesthesia care unit.…”

mentioning

confidence: 99%

A randomised controlled trial comparing sugammadex and neostigmine at different depths of neuromuscular blockade in patients undergoing laparoscopic surgery*

et al. 2012

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SummaryDeep neuromuscular blockade during certain surgical procedures may improve operating conditions. Sugammadex can be used to reverse deep neuromuscular blockade without waiting for spontaneous recovery. This randomised study compared recovery times from neuromuscular blockade induced by rocuronium 0.6 mg.kg , using sugammadex 4 mg.kg )1 administered at 1-2 post-tetanic count (deep blockade) or neostigmine 50 lg.kg )1 (plus atropine 10 lg.kg )1 ) administered at the re-appearance of the second twitch of a train-of-four stimulation (moderate blockade), in patients undergoing laparoscopic surgery. The primary efficacy variable was the time from the start of sugammadex ⁄ neostigmine administration to recovery of the train-of-four ratio to 0.9. Patients receiving sugammadex recovered 3.4 times faster than patients receiving neostigmine (geometric mean (95% CI) recovery times of 2.4 (2.1-2.7) and 8.4 (7.2-9.8) min, respectively, p < 0.0001). Moreover, 94% (62 ⁄ 66) of sugammadex-treated patients recovered within 5 min, vs 20% (13 ⁄ 65) of neostigmine-treated patients, despite the difference in the depth of neuromuscular blockade at the time of administration of both drugs. The ability to provide deep neuromuscular blockade throughout the procedure but still permit reversal at the end of surgery may enable improved surgical access and an enhanced visual field.

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“…De forma rutinaria, la ventilación pulmonar, la protección y el mantenimiento de la permeabilidad de las vías aéreas es lo que evaluamos al final de la cirugía 1,84 .…”

Section: Bloqueo Neuromuscular Residual (Bnmr)unclassified

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

Ruiz

Cayuela

Montes

et al. 2017

Revista Española de Anestesiología y Reanimación

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Residual neuromuscular block is a risk factor for postoperative pulmonary complications A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium

Abstract: Postoperative residual block caused by pancuronium is a significant risk factor for development of POPC.

Cited by 604 publications

References 18 publications

Review article: Age related alterations in respiratory function — anesthetic considerations

Review article: Age related alterations in respiratory function — anesthetic considerations

A randomised controlled trial comparing sugammadex and neostigmine at different depths of neuromuscular blockade in patients undergoing laparoscopic surgery*

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

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