Buwei Yu1, Baoyi Ouyang2, Shengjin Ge3, Yan Luo1, Jun Li4, Dongmei Ni5, Shuangfei Hu6, Hui Xu7, Jin Liu8, Su Min9, Longyun Li10, Zhengliang Ma11, Kangjie Xie12, Changhong Miao13, Xinmin Wu5. 1. a a Department of Anesthesiology , Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China. 2. b b The First Affiliated hospital of Guangzhou Medical University , Guangzhou , China. 3. c c Zhongshan Hospital of Fudan University , Shanghai , China. 4. d d The Second Affiliated Hospital of Wenzhou Medical College , Wenzhou , China. 5. e e Peking University First Hospital , Beijing , China. 6. f f Zhejiang Provincial People's Hospital , Hangzhou , China. 7. g g Tongji Hospital, Tongji Medical College of Huazhong University of Science & Technology , Wuhan , China. 8. h h West China Hospital, West China School of Medicine, Sichuan University , Chengdu , China. 9. i i The First Affiliated Hospital of Chongqing Medical University , Chongqing , China. 10. j j China-Japan Union Hospital, Jilin University , Changchun , China. 11. k k Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School , Nanjing , China. 12. l l Zhejiang Cancer Hospital , Hangzhou , China. 13. m m Fudan University Shanghai Cancer Center , Shanghai , China.
Abstract
OBJECTIVE: Evidences demonstrate that postoperative residual neuromuscular blockade (rNMB) is a primary and frequent anesthetic risk factor for postoperative complications. This study was designed to mitigate the paucity of data regarding the occurrence and degree of rNMB in a real-life setting. METHODS: This prospective, multicenter, anesthetist-blind, observational study enrolled 1571 Chinese adults undergoing elective open or laparoscopic abdominal surgery lasting ≤4 hours from 32 hospitals across China. The patients received anesthesia in accordance with routine practice at the study site. Neuromuscular blockade (NMB) was monitored using acceleromyography, with rNMB defined as a train-of-four (TOF) ratio <0.9. RESULTS: The patients' mean age was 46 years and 71% were female. The procedures included laparoscopic (67%), open abdominal (31%), and laparoscopic to open abdominal (2%). NMB was reversed with neostigmine in 78% of patients. The overall incidence of rNMB at extubation was 57.8%, and the proportions of participant with TOF ratios <0.6, 0.6-0.7, 0.7-0.8, 0.8-0.9 were 22.9%, 6.9%, 11.1% and 16.9%, respectively, immediately prior to endotracheal extubation. Age <45 years (OR = 0.630, 95% CI = 0.496-0.801, p = 0.002), use of one neuromuscular blocking agent (NMBA) (OR = 0.387, 95% CI = 0.243-0.618, p < 0.0001), time from neostigmine administration to endotracheal extubation ≥10 min (OR = 0.513, 95% CI = 0.400-0.658, p < 0.0001) and time from last NMBA administration to endotracheal extubation ≥60 min (OR = 0.902, 95% CI = 0.801-0.989, p = 0411) were correlated with non-rNMB at the time of extubation. CONCLUSIONS: This observational study demonstrated that the overall incidence of rNMB at the time of endotracheal extubation was high in Chinese patients undergoing abdominal procedures, which necessitates appropriate management in current real-life practice. CLINICAL TRIAL REGISTRY NUMBER: NCT01871064.
OBJECTIVE: Evidences demonstrate that postoperative residual neuromuscular blockade (rNMB) is a primary and frequent anesthetic risk factor for postoperative complications. This study was designed to mitigate the paucity of data regarding the occurrence and degree of rNMB in a real-life setting. METHODS: This prospective, multicenter, anesthetist-blind, observational study enrolled 1571 Chinese adults undergoing elective open or laparoscopic abdominal surgery lasting ≤4 hours from 32 hospitals across China. The patients received anesthesia in accordance with routine practice at the study site. Neuromuscular blockade (NMB) was monitored using acceleromyography, with rNMB defined as a train-of-four (TOF) ratio <0.9. RESULTS: The patients' mean age was 46 years and 71% were female. The procedures included laparoscopic (67%), open abdominal (31%), and laparoscopic to open abdominal (2%). NMB was reversed with neostigmine in 78% of patients. The overall incidence of rNMB at extubation was 57.8%, and the proportions of participant with TOF ratios <0.6, 0.6-0.7, 0.7-0.8, 0.8-0.9 were 22.9%, 6.9%, 11.1% and 16.9%, respectively, immediately prior to endotracheal extubation. Age <45 years (OR = 0.630, 95% CI = 0.496-0.801, p = 0.002), use of one neuromuscular blocking agent (NMBA) (OR = 0.387, 95% CI = 0.243-0.618, p < 0.0001), time from neostigmine administration to endotracheal extubation ≥10 min (OR = 0.513, 95% CI = 0.400-0.658, p < 0.0001) and time from last NMBA administration to endotracheal extubation ≥60 min (OR = 0.902, 95% CI = 0.801-0.989, p = 0411) were correlated with non-rNMB at the time of extubation. CONCLUSIONS: This observational study demonstrated that the overall incidence of rNMB at the time of endotracheal extubation was high in Chinese patients undergoing abdominal procedures, which necessitates appropriate management in current real-life practice. CLINICAL TRIAL REGISTRY NUMBER: NCT01871064.
Entities:
Keywords:
General anesthesia; Observational study; Residual neuromuscular blockade; Train-of-four monitoring
Authors: Timur Z Dubovoy; Leif Saager; Nirav J Shah; Douglas A Colquhoun; Michael R Mathis; Steven Kapeles; Graciela Mentz; Sachin Kheterpal; Michelle T Vaughn Journal: Anesth Analg Date: 2020-11 Impact factor: 6.627