Journal ArticleDOI
Residual neuromuscular block is a risk factor for postoperative pulmonary complications: A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium
H. Berg,Jørgen Viby-Mogensen,J. Roed,C. R. Mortensen,J. Engbæk,L. T. Skovgaard,J. J. Krintel +6 more
TLDR
The aim of this study was to compare the incidence of POPC following the use of pancuronium, atracurium, and vecuronium and to examine the effect of residual neuromuscular block on the incidence.Abstract:
Background: After anaesthesia involving pancuronium a high incidence of both residual neuromuscular block and postoperative pulmonary complications (POPC) has been reported. The aim of this study was to compare the incidence of POPC following the use of pancuronium, atracurium, and vecuronium, and to examine the effect of residual neuromuscular block on the incidence of POPC.
Methods: A total of 691 adult patients undergoing abdominal, gynaecological, or orthopaedic surgery under general anaesthesia were randomised to receive either pancuronium, atracurium, or vecuronium. Perioperatively, the response to train-of-four (TOF) nerve stimulation was evaluated manually. Post-operatively, the TOF ratios were measured mechanomyograph-ically, and through a 6-day follow-up the patients were examined for pulmonary complications.
Results: The incidence of residual block, defined as a TOF ratio <0.7, was significantly higher in the pancuronium group (59/226: 26%) than in the atracurium/vecuronium groups (24/450: 5.3%). In the pancuronium group, significantly more patients with residual block developed POPC (10/59: 16.9%) as compared to patients without residual block (8/167 4.8%). In the atracurium/vecuronium groups, the incidence of POPC was not significantly different in patients with (1/24: 4.2%) or without (23/426: 5.4%) residual block. Multiple regression analysis indicated that abdominal surgery, age, long-lasting surgery, and a TOF ratio<0.7 following the use of pancuronium were potential risk factors for the development of POPC.
Conclusion: Postoperative residual block caused by pancuronium is a significant risk factor for development of POPC.read more
Citations
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Journal ArticleDOI
Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society.
Warren B. Chow,Warren B. Chow,Ronnie A. Rosenthal,Ryan P. Merkow,Clifford Y. Ko,Clifford Y. Ko,Nestor F. Esnaola +6 more
TL;DR: The population of the United States is growing and aging, and the fastest growing segment of this group (individuals 85 years and older) is expected to triple in number over the next 4 decades.
Journal ArticleDOI
Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit
Glenn S. Murphy,Joseph W. Szokol,Jesse H. Marymont,Steven Greenberg,Michael J. Avram,Jeffery S. Vender +5 more
TL;DR: It is suggested that incomplete neuromuscular recovery is an important contributing factor in the development of adverse respiratory events in the PACU, which was absent in control patients without CREs.
Journal ArticleDOI
Preoperative Pulmonary Evaluation
TL;DR: Patient- and procedure-related risk factors, clinical evaluation, pulmonary-function testing, and risk-reduction strategies are reviewed, finding that pulmonary complications are as common as postoperative cardiac complications.
Journal ArticleDOI
Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians.
TL;DR: This current systematic review synthesizes the evidence on preventive strategies and focuses on atelectasis, pneumonia, and respiratory failure and identifies patient, procedure, and laboratory risk factors for postoperative pulmonary complications.
Journal ArticleDOI
Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action.
TL;DR: After a single dose of intermediate-duration muscle relaxant and no reversal, residual paralysis is common, even more than 2 h after the administration of muscle relaxants, as shown in patients enrolled in this study.
References
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Journal ArticleDOI
Good Clinical Research Practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents
Jørgen Viby-Mogensen,J. Engbæk,L. I. Eriksson,L. Gramstad,Erik W. Jensen,F. S. Jensen,Z. J. Koscielniak-Nielsen,Lene Theil Skovgaard,Doris Østergaard +8 more
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Effect of a vecuronium-induced partial neuromuscular block on hypoxic ventilatory response.
TL;DR: It is concluded that a veCuronium-induced partial neuromuscular block impairs HVR more than it does HCVR in humans, suggesting an effect of vecuronium on carotid body hypoxic chemosensitivity.
Journal ArticleDOI
Clinical assessment of neuromuscular transmission
TL;DR: Clinical assessment of neuromuscular transmissionの 始 ま りであ ろう。