TY - JOUR
T1 - Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR)
T2 - a multicentre, prospective observational study
AU - Kirmeier, Eva
AU - Eriksson, Lars I
AU - Lewald, Heidrun
AU - Jonsson Fagerlund, Malin
AU - Hoeft, Andreas
AU - Hollmann, Markus
AU - Meistelman, Claude
AU - Hunter, Jennifer M
AU - Ulm, Kurt
AU - Blobner, Manfred
AU - POPULAR Contributors
A2 - Ekelund, Kim
A2 - Afshari, Arash
N1 - Correction to
Lancet Respir Med 2019;
7: 129–40
Kirmeier E, Eriksson LI, Lewald H,
et al. Post-anaesthesia pulmonary
complications after use of muscle
relaxants (POPULAR): a multicentre,
prospective observational study.
Lancet Respir Med 2019; 7: 129–40—
In table 1 of this Article, the number
and percentage of patients who were
given a reversal agent was incorrect
for patients receiving neuromuscular
blocking agents (8927 [52·1%]),
any neuromuscular monitoring
(4259 [62·0%]), and quantitative
neuromuscular monitoring (2308
[55·2%]). In table 3, the incidences of
patients with postoperative pulmonary
complications who were extubated
at a train-of-four ratio of ≥0·9, and
those who had received sugammadex (vs neostigmine), were incorrectly
presented in the wrong columns (the
values in the ‘Key factor does not apply’
and ‘Key factor applies’ columns were
the wrong way round). Additionally,
the list of POPULAR contributors on
the online version of the report has
been corrected (the list in the appendix
at the time of publication was correct).
These corrections have been made to
the online version as of Nov 6, 2018,
and the printed version is correct.
PY - 2019/2/7
Y1 - 2019/2/7
N2 - 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.
AB - 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.
KW - Health Sciences
UR - http://www.scopus.com/inward/record.url?scp=85060297287&partnerID=8YFLogxK
U2 - 10.1016/S2213-2600(18)30294-7
DO - 10.1016/S2213-2600(18)30294-7
M3 - Journal article
C2 - 30224322
SN - 2213-2600
VL - 7
SP - 129
EP - 140
JO - The Lancet Respiratory Medicine
JF - The Lancet Respiratory Medicine
IS - 2
ER -