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

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Abstract

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during generalanaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the useof neuromuscular blocking agents is associated with postoperative pulmonary complications.Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospitalprocedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at dischargewere prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examinationwithin 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperativepulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses wereadjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) andadjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513.Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscularblocking agents was associated with an increased incidence of postoperative pulmonary complications in patients whohad undergone general anaesthesia (1658 [7·6%] of 21694); 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 anaesthetisedwithout 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 sugammadexinstead 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 ata 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 anincreased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits ofneuromuscular blockade against the increased risk of postoperative pulmonary complications.
Lingua originaleEnglish
pagine (da-a)129-140
Numero di pagine12
RivistaThe Lancet Respiratory Medicine
Volume7
Stato di pubblicazionePublished - 2019

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All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine

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