Effect of Deep versus Moderate Neuromuscular Blockade on Quantitatively Assessed Postoperative Atelectasis Using...

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Respiratory Physiology

Background:

• Postoperative atelectasis is a significant complication following thoracic surgery.
• Intraoperative deep neuromuscular blockade may improve surgical conditions but poses a risk of residual paralysis, potentially worsening atelectasis.
• Ensuring full neuromuscular reversal before extubation is crucial.

Purpose of the Study:

• To quantitatively compare the effect of deep versus moderate neuromuscular blockade on postoperative atelectasis using chest computed tomography.
• To assess the impact of intraoperative neuromuscular blockade depth on lung mechanics.

Main Methods:

• Randomized controlled trial comparing moderate (Group M) and deep (Group D) neuromuscular blockade during thoracic surgery.
• Primary outcome: proportion and volume of atelectasis measured by chest CT on postoperative day 2.
• Secondary outcome: comparison of intraoperative dynamic lung compliance.

Main Results:

• No significant difference in the proportion (1.32% vs 1.41%) or volume (38.2 mL vs 31.9 mL) of postoperative atelectasis between Group M and Group D.
• Mean lung compliance during one-lung ventilation was significantly higher in Group D (26.6%) compared to Group M (24.1%).
• Atelectasis in both groups may be influenced by unconsidered lung protective ventilation factors.

Conclusions:

• Intraoperative deep neuromuscular blockade does not increase postoperative atelectasis compared to moderate blockade when full neuromuscular reversal is confirmed.
• Deep neuromuscular blockade may be associated with improved intraoperative lung compliance during thoracic surgery.