Effects of high neuromuscular blocking agent dose on post-operative respiratory complications in infants and children

Flora T. Scheffenbichler, Maíra I. Rudolph, Sabine Friedrich, Friederike C. Althoff, Xinling Xu, Aaron C. Spicer, Maria Patrocínio, Pauline Y. Ng, Hao Deng, Thomas A. Anderson, Matthias Eikermann

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: This study evaluated the association between neuromuscular blocking agent dose and post-operative respiratory complications in infants and children. Methods: Data from 6507 general anaesthetics provided to children aged 0-10 years undergoing surgery were analysed to examine the effects of neuromuscular blocking agent dose on post-operative respiratory complications (primary endpoint) and secondary endpoints. Confounder-adjusted analyses addressed age, surgical duration, and comorbidity burden. Results: In confounder-adjusted analyses, high doses of neuromuscular blocking agents were associated with higher risk of post-operative respiratory complications (OR 2.27; 95% CI 1.12-4.59; P =.022). The effect was modified by age (P-for-interaction =.016) towards a more substantial risk in infants ≤1 year (OR 3.84; 95% CI 1.35-10.94; P =.012), by duration of surgery (P-for-interaction =.006) towards a higher difference in odds for surgeries <90 minutes (OR 4.25; 95% CI 1.19-15.18; P =.026), and by ASA physical status (P-for-interaction =.015) with a greater effect among patients with higher operative risk (ASA >1: OR 3.17; 95% CI 1.43-7.04; P =.005). Neostigmine reversal did not modify the association between neuromuscular blocking agents and post-operative respiratory complications (P-for-interaction =.38). Instrumental variable analysis confirmed that high doses of neuromuscular blocking agents were associated with post-operative respiratory complications (probit coefficient 0.25; 95% CI 0.04-0.46; P =.022), demonstrating robust results regarding concerns of unobserved confounding. Conclusions: High dose of neuromuscular blocking agents is associated with post-operative respiratory complications. We have identified subcohorts of paediatric patients who are particularly vulnerable to the respiratory side-effects of neuromuscular blocking agents: infants, paediatric patients undergoing surgeries of short duration, and those with a high ASA risk score.

Original languageEnglish (US)
Pages (from-to)156-167
Number of pages12
JournalActa Anaesthesiologica Scandinavica
Volume64
Issue number2
DOIs
StatePublished - Feb 1 2020
Externally publishedYes

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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