Postoperative complications with neuromuscular blocking drugs and/or reversal agents in obstructive sleep apnea patients: a systematic review.

Neuromuscular blocking drugs (NMBD) achieve intraoperative muscle relaxation to facilitate intubation and surgical procedures. Incomplete reversal of NMBD can lead to adverse postoperative events which is of particular concern in patients with obstructive sleep apnea (OSA). This systematic review aimed to determine whether: 1) OSA patients are at higher risk of postoperative complications from the use of NMBD compared to patients without OSA, and 2) whether the choice of NMBD reversal agent would affect the risk of postoperative complications in patients with OSA. The systematic literature search revealed five eligible studies out of 4123 (2 RCTs and 3 observational studies), while the level of evidence was deemed as low to moderate. Overall, OSA patients with intraoperative NMBD use may be at higher risk for postoperative hypoxemia, respiratory failure and residual neuromuscular blockade when compared to non-OSA patients. There is some, albeit very limited evidence suggesting that NMBD reversal with sugammadex may be associated with less PPCs than neostigmine in OSA. More high-quality studies are needed.