Dose-dependent Association between Intermediate-acting Neuromuscular-blocking Agents and Postoperative Respiratory...

Area of Science:

• Anesthesiology
• Pharmacology
• Patient Safety

Background:

• Neuromuscular-blocking agents (NMBAs) effects can prolong with repeated doses.
• High intraoperative NMBA doses may compromise postoperative respiratory safety.

Purpose of the Study:

• To investigate the dose-dependent association between NMBAs and postoperative respiratory complications.
• To evaluate the impact of neostigmine reversal on these complications.

Main Methods:

• A hospital-based registry study of 48,499 patients receiving intermediate-acting NMBAs.
• Analysis controlled for patient, anesthesia, and surgical complexity risk factors.
• Secondary analysis assessed neostigmine dose; post hoc analysis examined appropriate reversal (neostigmine ≤ 60 μg/kg with TOF count ≥ 2).

Main Results:

• High NMBA doses correlated with increased risk of postoperative respiratory complications (OR, 1.28).
• Neostigmine administration showed a dose-dependent increase in complication risk (OR, 1.51).
• Appropriate neostigmine reversal eliminated the NMBA dose-response relationship with complications (OR, 0.98).

Conclusions:

• NMBA use is dose-dependently linked to higher postoperative respiratory complication rates.
• Neostigmine reversal also demonstrated a dose-dependent risk increase.
• Proper neostigmine use, guided by neuromuscular monitoring, may prevent NMBA-associated respiratory complications.