TY - JOUR
T1 - Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR)
T2 - a multicentre, prospective observational study
AU - POPULAR Contributors
AU - Kirmeier, Eva
AU - Eriksson, Lars I.
AU - Lewald, Heidrun
AU - Jonsson Fagerlund, Malin
AU - Hoeft, Andreas
AU - Hollmann, Markus
AU - Meistelman, Claude
AU - Hunter, Jennifer M.
AU - Ulm, Kurt
AU - Blobner, Manfred
AU - Abad Gurumeta, Alfredo
AU - Abernethy, Caroline
AU - Abigail, Patrick
AU - Achaibar, Kira
AU - Adam, Emily
AU - Afshari, Arash
AU - Agudelo Montoya, M. Elizabeth
AU - Akgün, Fatma Nur
AU - Aletti, Gabriele
AU - Alkış, Neslihan
AU - Allan, Katie
AU - Allan, Ashley
AU - Allaouchiche, Bernard
AU - Allcock, Clare
AU - Almasy, Emoke
AU - Amey, Isobel
AU - Amigoni, Maria
AU - Andersen, Elin
AU - Andersson, Peder
AU - Anipchenko, Natalya
AU - Antunes, Pedro
AU - Armstrong, Earlene
AU - Aslam, Tayyba Naz
AU - Aslin, Bjorn
AU - Assunção, José Pedro
AU - Ausserer, Julia
AU - Avvai, Mary
AU - Awad, Nahla
AU - Ayas Montero, Begoña
AU - Ayuso, Mercedes
AU - Azevedo, Patricia
AU - Badarau, Victoria
AU - Badescu, Roxana
AU - Baiardo Redaelli, Martina
AU - Baird, Colin
AU - Baird, Yolanda
AU - Boer, Christa
AU - Koers, Lena
AU - Kooij, Fabian
AU - Zonneveldt, Harry
AU - Schultz, Marcus
N1 - Copyright © 2019 Elsevier Ltd. All rights reserved.
PY - 2019/2
Y1 - 2019/2
N2 - Background: Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods: We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings: Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21 694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj −4·4%, 95% CI −5·5 to −3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj −2·6%, 95% CI −3·9 to −1·4) and the administration of reversal agents (1·23, 1·07–1·41; −1·9%, −3·2 to −0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj −0·3%, 95% CI −2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; −0·4%, −3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation: We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications. Funding: European Society of Anaesthesiology.
AB - Background: Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods: We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings: Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21 694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj −4·4%, 95% CI −5·5 to −3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj −2·6%, 95% CI −3·9 to −1·4) and the administration of reversal agents (1·23, 1·07–1·41; −1·9%, −3·2 to −0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj −0·3%, 95% CI −2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; −0·4%, −3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation: We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications. Funding: European Society of Anaesthesiology.
UR - http://www.scopus.com/inward/record.url?scp=85060297287&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/S2213-2600(18)30294-7
DO - https://doi.org/10.1016/S2213-2600(18)30294-7
M3 - Article
C2 - 30224322
SN - 2213-2600
VL - 7
SP - 129
EP - 140
JO - The Lancet Respiratory Medicine
JF - The Lancet Respiratory Medicine
IS - 2
ER -