Incomplete Reversal of Neuromuscular Block, Postoperative Respiratory Complications
Conditions
Keywords
Muscle relaxants, Postoperative complications, respiratory, General anesthesia, Postanesthesia care unit, Neuromuscular block reversal
Brief summary
Residual neuromuscular block (RNMB) is frequent in the immediate postoperative period and is a source of complications, mainly respiratory. The incidence is variable due to multiple factors. In Spain the incidence is unknown. The investigators hypothesize that a number of patients in the postanesthesia care unit (PACU) present with RNMB after general anesthesia using intermediate action neuromuscular block agents (NMBA). The main objective is to know the incidence of RNMB in Spanish hospitals. Secondary objectives are to observe the possible relationship with other pre- and intraoperative factors.
Detailed description
Residual neuromuscular block (RNMB) is frequent in the immediate postoperative period and is a source of complications, mainly respiratory. This includes recovery delay or hospital discharge delays, respiratory insufficiency or infections, unforeseen ICU admissions, and prolonged ICU stays. The incidence is variable due to multiple factors. Age, gender, surgery, NMBA type and doses, temperature, medications, etc. In several studies it has been found and incidence between 6-80%. Few studies have been focused in evaluating the incidence in the whole country, as representing a global anesthesia practice. In Spain the incidence is unknown. The investigators hypothesize that a number of patients in the postanesthesia care unit (PACU) present with RNMB after general anesthesia using intermediate action NMBA. The main objective is to know the incidence of RNMB in Spanish hospitals, by means of an observational cross-sectional multicenter study . Secondary objectives are to observe the possible relationship with other pre- and intraoperative factors.
Interventions
DEVICEAccelerometry
Application of TOF stimulus (40 mA, three to four times) and recording TOFr in the PACU
Sponsors
General University Hospital of Valencia
Hospital General Universitario Gregorio Marañon
University of Valencia
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients \>18 years-old * General anesthesia with non-depolarizing NMBA * Transferred extubated on spontaneous ventilation to the PACU
Exclusion criteria
* American Society of Anesthesiologists physical status IV-V * emergency and cardiac surgery * patients unable to respond adequately at the moment of pre- or postoperative evaluation (psychiatric diseases, excessive somnolence, agitation, etc.) * noncompensated diabetes mellitus or diabetic neuropathy * symptomatic severe hypothyroidism (or untreated), or scheduled for total thyroidectomy * chronic or acute renal insufficiency * severe hepatopathy (Child-Pugh B, C) * intraoperative blood transfusion \>3 blood units * intraoperative maintained arterial hypotension * arrival to the PACU intubated or with instrumented airway (including surgical) * pre- or perioperative drugs intake affecting the neuromuscular transmission * neuromuscular diseases affecting the physiology of the neuromuscular system
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Residual neuromuscular block incidence (TOFr<0.9) measured by accelerometry in the PACU | Upon arrival to the PACU. Single evaluation. | Patients operated on under general anesthesia including intermediate duration NMBA were evaluated by means of an accelerometer in the PACU immediately upon arrival. Train-of-four ratio (TOFr) is evaluated. The evaluator does'nt know the patient-related information, including intraoperative management. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Respiratory or airway postoperative complications in the PACU | During PACU stay, an expected average of 4 hours | Evaluation of respiratory complications or events in the PACU (asking the anesthesiologist in charge or PACU medical record) to discharge to the ward. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Relationship of RNMB with preoperative patient related factors | Upon patients arrival to the PACU | Analysis of the preoperative visit record and anesthesia record: ASA class, and patient's demographics and characteristics |
| Relationship of RNMB with intraoperative anesthesia-related factors | Upon PACU arrival | anesthesiologist-in-charge experience, type of anesthesia, intraoperative drugs administered and doses, reversal drugs and doses. |
| Relationship of RNMB with surgery-related factors | Upon PACU arrival | Relationship of RNMB with surgery related factors (surgical speciality, type of surgery -high risk vs low to intermedium risk, laparoscopic vs no laparoscopic-, duration), blood losses. |
Countries
Spain
Outcome results
None listed