Neuromuscular Blocking Drugs and Postoperative Pulmonary Complications
- 37 Downloads
Purpose of Review
The purpose of this chapter is to provide a brief review of the literature around the relationship between the use of neuromuscular blocking drugs and subsequent postoperative pulmonary complications.
A recent series of retrospective studies evaluating the use of neuromuscular blocking agents and postoperative complications have demonstrated growing evidence for a clear relationship between the use of the agents and downstream complications. The frequency of postoperative respiratory problems seems to be mitigated to some degree through the appropriate use of reversal agents.
Care should be exercised when administering neuromuscular blocking agents during surgical procedures. Appropriate monitoring of neuromuscular transmission should be used along with a strategy to provide adequate reversal at the end of the surgical procedure.
KeywordsNeuromuscular blocker Postoperative complications Pulmonary Anesthesiology Anesthesia reversal Postoperative pneumonia
Compliance with Ethical Standards
Conflict of Interest
Letha Mathews and Jesse M. Ehrenfeld declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 11.• Belcher AW, Leung S, Cohen B, Yang D, Mascha EJ, Turan A, et al. Incidence of complications in the post-anesthesia care unit and associated healthcare utilization in patients undergoing non-cardiac surgery requiring neuromuscular blockade 2005–2013: a single center study. J Clin Anesth. 2017;43:33–8. https://doi.org/10.1016/j.jclinane.2017.09.005. Published in 2013, a large study of 128,886 patients who had received a neuromuscular blocking agent between April 2005 and December 2013. CrossRefPubMedGoogle Scholar
- 12.• Bronsert MR, Henderson WG, Monk TG, Richman JS, Nguyen JD, Sum-Ping JT, et al. Intermediate-acting nondepolarizing neuromuscular blocking agents and risk of postoperative 30-day morbidity and mortality, and long-term survival. Anesth Analg. 2017;124(5):1476–83. https://doi.org/10.1213/ANE.0000000000001848. Published in 2017, a study of respiratory complications after neuromuscular blockade in 11,355 Veteran Affair Health System patients. CrossRefPubMedGoogle Scholar
- 13.•• Bulka CM, Terekhov MA, Martin BJ, Dmochowski RR, Hayes RM, Ehrenfeld JM. Nondepolarizing neuromuscular blocking agents, reversal, and risk of postoperative pneumonia. Anesthesiology. 2016;125(4):647–55. https://doi.org/10.1097/ALN.0000000000001279. Published in 2016, this study of 13,100 surgical cases compared surgical patients who received reversal with neostigmine to patients who did not and found that nonreversal was associated with an increased risk of postoperative pneumonia. CrossRefPubMedGoogle Scholar
- 14.• Martinez-Ubieto J, Ortega-Lucea S, Pascual-Bellosta A, Arazo-Iglesias I, Gil-Bona J, Jimenez-Bernardo T, et al. Prospective study of residual neuromuscular block and postoperative respiratory complications in patients reversed with neostigmine versus sugammadex. Minerva Anestesiol. 2016;82(7):735–42. Published in 2016, this prospective study of 558 patients evaluated residual neuromuscular block and postoperative respiratory complications in patients reversed with neostigmine versus sugammadex. PubMedGoogle Scholar
- 16.Ledowski T, Falke L, Johnston F, Gillies E, Greenaway M, De Mel A, et al. Retrospective investigation of postoperative outcome after reversal of residual neuromuscular blockade: sugammadex, neostigmine or no reversal. Eur J Anaesthesiol. 2014;31(8):423–9. https://doi.org/10.1097/EJA.0000000000000010.CrossRefPubMedGoogle Scholar
- 18.Thomsen JLD, Mathiesen O, Hagi-Pedersen D, Skovgaard LT, Ostergaard D, Engbaek J, et al. Improving neuromuscular monitoring and reducing residual neuromuscular blockade with E-learning: protocol for the multicenter interrupted time series INVERT study. JMIR Res Protoc. 2017;6(10):e192. https://doi.org/10.2196/resprot.7527.CrossRefPubMedPubMedCentralGoogle Scholar