Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

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

Research output: Contribution to journalJournal articleResearchpeer-review

  1. The long-lasting dark shadow of past and present smoking

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Non-eosinophilic severe exacerbations of COPD: what about antibiotics? - Authors' reply

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Reply to: will one hour less make any difference?

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Clonidine in pediatric anesthesia: the new panacea or a drug still looking for an indication?

    Research output: Contribution to journalReviewResearchpeer-review

  3. Mislykket epiduralblokade under fødsel

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Clear fluids fasting for elective paediatric anaesthesia: The European Society of Anaesthesiology consensus statement

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

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.

Original languageEnglish
JournalThe Lancet Respiratory Medicine
Pages (from-to)129
Number of pages140
ISSN2213-2600
DOIs
Publication statusPublished - 7 Feb 2019

ID: 56153595