Neuromuscular Blocking Agents Up Post-Op Complications

WEDNESDAY, Oct. 17 (HealthDay News) -- Use of intermediate-acting non-depolarizing neuromuscular blocking agents during general anesthesia is associated with an increase in the risk of postoperative respiratory complications, according to a study published online Oct. 16 in BMJ.

Martina Grosse-Sundrup, M.D., from Harvard Medical School in Boston, and colleagues conducted a prospective, propensity score-matched cohort study to assess the incidence of postoperative respiratory complications linked to use of intermediate-acting neuromuscular blocking agents. A total of 18,579 surgical patients who received intermediate-acting neuromuscular blocking agents were matched by propensity score to 18,579 reference patients who did not receive these agents.

The researchers observed a significantly increased risk of desaturation <90 percent after extubation with use of intermediate-acting neuromuscular blocking agents (odds ratio [OR], 1.36). The risk of reintubation requiring unplanned admission to an intensive care unit was also increased (OR, 1.40). The risk was not decreased with qualitative monitoring of neuromuscular transmission. Neostigmine reversal significantly increased the risks of postoperative desaturation <90 percent and reintubation (OR, 1.32 and 1.76, respectively).

"Our data raise concern about the potential adverse outcome events of non-depolarizing neuromuscular blocking agents, and further targeted research is warranted to resolve remaining questions," the authors write. "In summary, we found that use of intermediate-acting neuromuscular blocking agents during anesthesia leads to an increased risk of developing clinically meaningful respiratory complications."

Two authors disclosed financial ties to the pharmaceutical industry.

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