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Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

医学 前瞻性队列研究 麻醉 入射(几何) 优势比 全身麻醉 队列研究 观察研究 外科 不利影响 内科学 光学 物理
作者
Eva Kirmeier,Lars I. Eriksson,Heidrun Lewald,Malin Jonsson Fagerlund,Andreas Hoeft,Markus W. Hollmann,Claude Meistelman,Jennifer M. Hunter,Kurt Ulm,Manfred Blobner,Alfredo Abad‐Gurumeta,Caroline Abernethy,Abigail Patrick,Kira Achaibar,Emily Adam,Arash Afshari,M. Elizabeth Agudelo Montoya,Fatma Nur Akgün,Gabriele Aletti,Neslihan Alkış,Katie Allan,Ashley Allan,Bernard Allaouchiche,Clare Allcock,Emőke Almásy,Isobel Amey,Maria Amigoni,E W Andersen,Peder Andersson,N. N. Anipchenko,Pedro E. Antunes,Earlene Armstrong,Tayyba Naz Aslam,Bjorn Aslin,José Pedro Assunção,Julia Ausserer,Mary Avvai,Nahla M. Awad,Begoña Ayas Montero,Mercedes Ayuso,Patrícia Ribeiro Azevedo,Victoria Badarau,Roxana Badescu,Martina Baiardo Redaelli,C.R.W. Baird,Yolanda Baird,Tim Baker,Packianathaswamy Balaji,Cristina Bălan,Alina Balandin,Carmen Balescu-Arion,Vilda Baliulienė,Jorge Baltasar Isabel,Saif Nasr Baluch,Daniela Bandrabur,Carla Bankewitz,Katrina Barber,Francesco Barbera,Helena Barcraft-Barnes,Valentina Barletti,Gill Barnett,Kirsty Baron,Ana Correia de Barros,Victoria Barsan,Pauline Bartlett,Chrysanthi Batistaki,Georg Baumgarten,Volkan Baytaş,Nigel Beauchamp,I.A. Becerra Cayetano,Stephanie Bell,Mattia Bellandi,Alessandro Belletti,Julio Belmonte Cuenca,Adela Benítez-Cano,Luigi Beretta,Marc Moritz Berger,Nicole Bergmann,Kristina Bergmark,María Bermúdez López,Monika Bernotaite,Charlotte J. P. Beurskens,Heena Bidd,Francesca Bifulco,Elena Bignami,Aleksandar Bilic,Diana Bilskienė,Petra Bischoff,Luke Bishop,Therese Bjonness,Hether Blaylock,Kate L. Blethyn,Thomas Blincoe,Ivan Blokhin,N Blunt,Christa Boer,Grégory Bois,Eleonora Bonicolini,Joanna Booth,Miroslawa Borecka-Kedzierska,Katarina Borstnar,Michał Borys,Emmanuel Boselli,Lionel Bouvet,R. Arthur Bouwman,Leonora Bowen,Sarah Bowrey,Leigh Boxall,Teodora Božić,Tom Bradley,Teresa Branco,Luca Brazzi,Marcella Brazzoni,Tracy Brear,N. Brogly,Farooq Brohi,Jacob Broms,Andrius Bubliauskas,Gea Erika Bucolo,Hartmut Buerkle,Donal J. Buggy,Wolfgang Buhre,Tomas Bukauskas,Francesco Butturini,Anders Byttner,Itahísa Cabrera Díaz,Adriana Calderón,Ricardo Calhau,Angel Callejo,Guy Cammu,Manuela Campesato,Özlem Selvi Can,Margarida Candeias,Andreea Cantor,Elsa Carise,Cristina Carmona,Joana Carreteiro,Cosima Carrieri,Anna Carter,M. Casal,Irene Casanova,Marco Cascella,Luis M. 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Tiganiuc,Hardo Toim,Dana Tomescu,Concezione Tommasino,Jessica Toni,Arturo Toninelli,Ilaria Toretti,Stephen Townley,Darius Trepenaitis,Brian Trethowan,Georgia Tsaousi,Aikaterini Tsiftsi,Adrada Tudor,Güldem Turan,Sanem Çakar Turhan,Dragana Unić-Stojanović,Christoph Unterbuchner,Carmen Unzueta,Jasna Uranjek,Tomaz Ursic,Simona Vaida,Silvia Valldeperas Ferrer,María Inmaculada Hernández,D Valsamidis,Rienk van Beek,Nick Van dasselaer,T. van der Beek,Yoni van Duivenvoorde,Wilton A. van Klei,Frans Van Poorter,Bas van Zaane,T. van Zundert,Rebekka van Zyl,Ana Milena Vargas Munoz,Nimu Varsani,Pedro Vasconcelos,Georgios Vassilakis,Tommaso Vecchiatini,Lubomír Večeřa,M. Vercauteren,B. C. Verdouw,Veerle J. Verheyen,Marco Verri,Luigi Giancarlo Vicari Sottosanti,Manuel Vico,Patricia Vidal Mitjans,Anna Vilardi,Daniela Vissicchio,Giovanni Vitale,Bibiana Vitković,Marcela P. Vizcaychipi,Alexandra Voicu,Minca Voje,Ivana Volfová,Carlo Alberto Volta,Theresa Von Lutterotti,Anna von Tiesenhausen,Simona Vrecic-Slabe,Dejan Vukcevic,Rade Vuković,P. Agostina Vullo,Andrew Wade,Hanna Wallberg,Jakob Walldén,Johann Wallner,Louise W. Sturesson,Davina Watson,Stefan Weber,Anna Wegiel Leskiewiq,Debbie Weller,Carine Wensing,Markus Werkmann,Henrik Westberg,Erik A. Wikstrom,Benedict Williams,Benedict Williams,Robin Wilson,Steffen Wirth,Mária Wittmann,Laura S. Wood,Stella Wright,Christian Zachoval,Massimo Zambon,Silvia Zampieri,Salvatore Zampone,Alberto Zangrillo,Gianluca Zani,Asta Zavackienė,Raphael Zieglerder,Harry Zonneveldt,Lajos Zsisku,Tom-Philipp Zucker,Maciej Żukowski,M. Zuleika,Darja Zupanĕiĕ
出处
期刊:The Lancet Respiratory Medicine [Elsevier]
卷期号:7 (2): 129-140 被引量:284
标识
DOI:10.1016/s2213-2600(18)30294-7
摘要

Summary

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.
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