Letters Intermediate acting neuromuscular blocking agents and postoperative respiratory complications

Neostigmine reversal doesn’t improve postoperative respiratory safety

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1460 (Published 19 March 2013) Cite this as: BMJ 2013;346:f1460
  1. Matthew J Meyer, research fellow1,
  2. Brian T Bateman, assistant professor12,
  3. Tobias Kurth, director of research345,
  4. Matthias Eikermann, associate professor16
  1. 1Department of Anaesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
  2. 2Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
  3. 3Inserm Unit 708-Neuroepidemiology, Bordeaux, France
  4. 4University of Bordeaux, Bordeaux, France
  5. 5Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
  6. 6Universitaetsklinikum Essen, Klinik fuer Anaesthesie und Intensivmedizin, Essen, Germany
  1. meikermann{at}partners.org

We recently reported an association between the intraoperative administration of intermediate acting non-depolarizing neuromuscular blocking agents and severe postoperative respiratory complications (oxygen desaturation, reintubation, and unplanned admission to intensive care).1 In secondary analyses we examined standard techniques to abate the effects of postoperative residual neuromuscular blockade—neostigmine administration and neuromuscular transmission monitoring. We found that their use did not reduce the risk of respiratory outcomes.

In the main and secondary analyses we used propensity score matching to control for confounding factors associated with the use of neuromuscular blocking agents. However, our methods did not account for confounding factors related to the use of neostigmine.

We conducted additional analyses to evaluate whether these recommended strategies to reduce the risk of residual neuromuscular blockade help …

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