期刊
JOURNAL OF CLINICAL ANESTHESIA
卷 43, 期 -, 页码 33-38出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jclinane.2017.09.005
关键词
Neuromuscular blockade; Postoperative complications; PACU
资金
- Merck Sharp & Dohme Corp. Whitehouse Station, NJ USA [8085011]
Study objective: The use of neuromuscular blockade agents (NMBA), had been associated with significant residual post-operative paralysis and morbidity. There is a lack of clinical evidence on incidence of postoperative complications within the post-anesthesia care unit (PACU) in patients exposed to intraoperative NMBA's. This study aims to estimate the incidence of post-operative complications associated with use of NMBAs and assessing its association with healthcare resource utilization. Design: Retrospective cohort. Setting: Post-anesthesia care unit in tertiary care center. Patients: Adults having non-cardiac surgery and receiving NMBAs between April-2005 and December-2013 Measurements: We assessed: 1) incidences of major and minor PACU complications, 2) incidence of any postoperative complication in patients receiving a NMBA reversal (neostigmine) vs. without. 3) We secondarily assessed the relationship between PACU complications and use of healthcare resources. Main results: The incidence of any major complications was 2.1% and that of any minor complication was 35.2%. ICU admission rate was 1.3% in patients without any complications, versus 5.2% in patients with any minor and 30.6% in patients with any major complication. ICU length of stay was prolonged in patients with any major (52.1 +/- 203 h), compared to patients with any minor (6.2 +/- 64 h) and with no complications (1.7 +/- 28 h). Patients who received a NMBA and neostigmine, compared to without neostigmine, had a lower incidence of any major complication (1.7% vs. 6.05%), rate of re-intubation (0.8% vs. 4.6%) and unplanned ICU admission (0.8% vs. 3.2%). Conclusions: This study documents that incidence of major PACU complications after non-cardiac surgery was 2.1%, with the most frequent complications being re-intubation and ICU admission. Patients receiving NMBA reversal were at a lower risk of re-intubation and unplanned ICU admission, justifying routine use of reversals. Complete NMBA reversals are crucial in reducing preventable patient harm and healthcare utilization. (C) 2017 Elsevier Inc. All rights reserved.
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