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Incidence of postoperative residual neuromuscular blockade - A multicenter, observational study in Portugal (INSPIRE
Simão Esteves1, Filinto Correia de Barros1, Catarina S Nunes2
1Anesthesiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Background:
Although the use of neuromuscular blocking agents (NMBAs) optimizes surgical conditions and facilitates tracheal intubation, it can lead to residual neuromuscular blockade (RNMB), with postoperative complications. This study aimed to assess RNMB incidence and management in Portugal.
Methods:
Prospective observational study of patients admitted for elective surgery requiring general anesthesia with nondepolarizing NMBAs between July 2018 and July 2019 at 10 Portuguese hospitals. The primary endpoint was the proportion of patients arriving at postanesthesia care unit (PACU) with a TOF ratio <0.9.
Results:
A total of 366 patients were included, with a median age of 59 years, and 89.1% classified as ASA II or III. Rocuronium was the most used NMBA (99.5%). A total of 96.2% of patients received a reversal agent, 96.6% of which sugammadex and 3.4% neostigmine. Twenty patients displayed a TOF ratio <0.9 at PACU arrival, representing an RNMB incidence of 5.5% (95% CI, 3.1%-7.8%). Only two patients displayed a TOF ratio <0.7. RNMB incidence was 16.7% with neostigmine and 5.3% with sugammadex (P = .114). In patients with intraoperative neuromuscular blockade (NMB) monitoring, RNMB incidence was 5% (95% CI, 2%-8%), which varied significantly according to the type of monitoring (P = .018). Incidence of adverse events was 3.3% (2 severe and 10 moderate).
Conclusions:
The reported overall incidence of 5.5% is numerically lower than results from similar observational studies. An appropriate pharmacological neuromuscular reversal strategy, guided by quantitative neuromuscular monitoring, has the potential to achieve even better results, converting RNMB from an unusual to a very rare or even inexistent event.
Insights
Residual neuromuscular blockade (RNMB) occurred in 5.5% of patients undergoing surgery in Portugal. Utilizing quantitative monitoring and appropriate reversal agents can significantly reduce this incidence.
Area of Science:
- Anesthesiology
- Pharmacology
- Patient Safety
Background:
- Neuromuscular blocking agents (NMBAs) are crucial for surgical procedures and intubation.
- Residual neuromuscular blockade (RNMB) is a significant complication post-anesthesia.
- RNMB can lead to adverse postoperative outcomes.
Purpose of the Study:
- To determine the incidence of RNMB in Portuguese hospitals.
- To evaluate the management strategies for RNMB.
- To identify factors influencing RNMB occurrence.
Main Methods:
- Prospective observational study conducted in 10 Portuguese hospitals.
- Inclusion of patients undergoing elective surgery with general anesthesia and nondepolarizing NMBAs.
- Primary endpoint: TOF ratio <0.9 upon arrival at the postanesthesia care unit (PACU).
Main Results:
- A total of 366 patients were analyzed; 5.5% incidence of RNMB (TOF ratio <0.9).
- Sugammadex was the predominant reversal agent (96.6%).
- RNMB incidence was lower with sugammadex (5.3%) compared to neostigmine (16.7%), though not statistically significant (P = .114).
- Quantitative neuromuscular monitoring was associated with a 5% RNMB incidence, varying by monitoring type (P = .018).
Conclusions:
- The observed 5.5% RNMB incidence is lower than in comparable studies.
- Effective neuromuscular reversal strategies, especially with quantitative monitoring, can minimize RNMB.
- RNMB can potentially be reduced to a very rare or nonexistent event.
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