This is a prospective cohort study in 18,579 patients at one institution who had intermediate-acting neuromuscular blocking agents during surgery, and matched them with 18,579 surgical patients who didn’t have the drugs. The main outcomes were oxygen desaturation after extubation, and reintubation requiring unplanned admission to an ICU within 7 days of surgery.
Among patients who had at least one neuromuscular blockade, 0.8% were reintubated, 5% had a desaturation event below 90%, 1.1% had a desaturation event below 80%, and 0.3% died.
The use of the intermediate-acting neuromuscular agents was associated with a 36% higher risk of a postoperative oxygen desaturation event below 90% (OR 1.36, 95% CI 1.23 to 1.51, P<0.01), and a 66% higher risk of a desaturation event below 80% (OR 1.66, 95% CI 1.34 to 2.07, P<0.01). The drugs also appeared to raise the risk of reintubation requiring admission to the ICU (OR 1.40, 95% CI 1.09 to 1.80, P<0.01), a “serious complication” that also increased the risk of dying in the hospital.
Most of the reintubations occurred within the first 3 days after surgery, with a peak during the first 24 hours. Qualitative monitoring of neuromuscular transmission did not decrease this risk and neostigmine reversal increased the risk of postoperative desaturation less than 90% (1.32, 1.20 to 1.46) and reintubation (1.76, 1.38 to 2.26).
The authors concluded that the use of intermediate acting neuromuscular blocking agents during anesthesia was associated with an increased risk of clinically meaningful respiratory complications.