![Sample our Bioscience journals, sign in here to start your access, Latest two full volumes FREE to you for 14 days]({"type":"image" , "src" : "/sda/5925/TOC-Subject-Sample-2021-Bioscience.jpg"})
Abstract
Objective:
Evidences demonstrate that postoperative residual neuromuscular blockade (rNMB) is a primary and frequent anesthetic risk factor for postoperative complications. This study was designed to mitigate the paucity of data regarding the occurrence and degree of rNMB in a real-life setting.
Methods:
This prospective, multicenter, anesthetist-blind, observational study enrolled 1571 Chinese adults undergoing elective open or laparoscopic abdominal surgery lasting ≤4 hours from 32 hospitals across China. The patients received anesthesia in accordance with routine practice at the study site. Neuromuscular blockade (NMB) was monitored using acceleromyography, with rNMB defined as a train-of-four (TOF) ratio <0.9.
Results:
The patients’ mean age was 46 years and 71% were female. The procedures included laparoscopic (67%), open abdominal (31%), and laparoscopic to open abdominal (2%). NMB was reversed with neostigmine in 78% of patients. The overall incidence of rNMB at extubation was 57.8%, and the proportions of participant with TOF ratios <0.6, 0.6–0.7, 0.7–0.8, 0.8–0.9 were 22.9%, 6.9%, 11.1% and 16.9%, respectively, immediately prior to endotracheal extubation. Age <45 years (OR = 0.630, 95% CI = 0.496–0.801, p = 0.002), use of one neuromuscular blocking agent (NMBA) (OR = 0.387, 95% CI = 0.243–0.618, p < 0.0001), time from neostigmine administration to endotracheal extubation ≥10 min (OR = 0.513, 95% CI = 0.400–0.658, p < 0.0001) and time from last NMBA administration to endotracheal extubation ≥60 min (OR = 0.902, 95% CI = 0.801–0.989, p = 0411) were correlated with non-rNMB at the time of extubation.
Conclusions:
This observational study demonstrated that the overall incidence of rNMB at the time of endotracheal extubation was high in Chinese patients undergoing abdominal procedures, which necessitates appropriate management in current real-life practice.
Clinical trial registry number:
NCT01871064.
Transparency
Declaration of funding
This study was supported by an unrestricted grant offered by MSD China Holding Co. Ltd.
Author contributions: All authors contributed to the intellectual development of this paper. X.W. had the original ideal for the study and is the guarantor. X.W., B.O., B.Y., S.G. and Y.L. contributed to the conception and design of the study and assembly of data. B.Y. wrote the first draft of the manuscript. X.W., B.O., S.G. and Y.L. supervised the study execution and data quality. S.H., H.X., J. Li, S.M., L.L. and Z.M. had primary responsibility for writing the report. J. Liu, D.N., K.X. and C.M. revised this manuscript. All authors reviewed the report and provided critical inputs for its revision. All listed authors meet the criteria for authorship set forth by the International Committee for Medical Journal Editors and assume responsibility for the direction and content.
Declaration of financial/other relationships
Investigators of this research received a modest fee to cover their clinical service. B.Y., B.O., S.G., Y.L., J.Li, D.N., S.H., H.X., J.Liu, S.M., L.L., Z.M., K.X., C.M., and X.W. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.
CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgments
The authors of the present study thank all RECITE–China investigators for their contribution to the successful completion of this study. The authors also thank Dr. Jihu Li of MSD China Holding Co. Ltd. for his assistance in preparing this manuscript and Dr. Jonathan Schelfhout, Merck & Co. Inc. for critically reviewing this paper.