TY - JOUR
T1 - REsidual Neuromuscular Block Prediction Score Versus Train-of-Four Ratio and Respiratory Outcomes
T2 - A Retrospective Cohort Study
AU - Patrocínio, Maria D.
AU - Shay, Denys
AU - Rudolph, Maíra I.
AU - Santer, Peter
AU - Grabitz, Stephanie D.
AU - Xu, Xinling
AU - Nabel, Sarah
AU - Bose, Somnath
AU - Eikermann, Matthias
N1 - Funding Information:
Name: Sarah Nabel, MSc. Contribution: This author helped with data analysis and interpretation, and manuscript writing. Conflicts of Interest: None. Name: Somnath Bose, MD. Contribution: This author helped with data analysis and interpretation, and manuscript writing. Conflicts of Interest: None. Name: Matthias Eikermann, MD, PhD. Contribution: This author oversaw all study stages, helped with study design, data analysis and interpretation, manuscript writing, and subsequent revisions of the manuscript. Conflicts of Interest: M. Eikermann received funding from Merck & Co, Inc for this investigator-initiated trial. Progress reports were sent to Merck & Co, Inc every trimester. This entity was not involved in study design, data collection, analysis or interpretation of data, or in any stages leading to submission for publication. He received philanthropic funds from Jeffrey and Judy Buzen and grants from Merck & Co, Inc. He holds a patent for the use of acyclic curcubiturils to reverse neuromuscular blocking agents and drugs of abuse. He is also guarantor of this manuscript and takes ownership for the integrity of the developed work. This manuscript was handled by: Ken B. Johnson, MD.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - BACKGROUND: Residual neuromuscular blockade is associated with an increased incidence of postoperative respiratory complications. The REsidual neuromuscular block Prediction Score (REPS) identifies patients at high risk for residual neuromuscular blockade after surgery. METHODS: A total of 101,510 adults undergoing noncardiac surgery under general anesthesia from October 2005 to December 2018 at a tertiary care center in Massachusetts were analyzed for the primary outcome of postoperative respiratory complications (invasive mechanical ventilation requirement within 7 postoperative days or immediate postextubation desaturation [oxygen saturation {Spo2} <90%] within 10 minutes). The primary objective was to assess the association between the REPS and respiratory complications. The secondary objective was to compare REPS and train-of-four (TOF) ratio <0.90 on the strength of their association with respiratory complications. RESULTS: A high REPS (≥4) was associated with an increase in odds of respiratory complications (adjusted odds ratio [OR], 1.13 [95% confidence interval {CI}, 1.06-1.21]; P <.001). In 6224 cases with available TOF ratio measurements, a low TOF ratio (<0.9) was associated with respiratory complications (adjusted OR, 1.43 [95% CI, 1.11-1.85]; P =.006), whereas a high REPS was not (adjusted OR, 0.96 [95% CI, 0.74-1.23]; P =.73) (P =.018 for comparison between ORs). CONCLUSIONS: The REPS may be implemented as a screening tool to encourage clinicians to use quantitative neuromuscular monitoring in patients at risk of residual neuromuscular blockade. A positive REPS should be followed by a quantitative assessment of the TOF ratio.
AB - BACKGROUND: Residual neuromuscular blockade is associated with an increased incidence of postoperative respiratory complications. The REsidual neuromuscular block Prediction Score (REPS) identifies patients at high risk for residual neuromuscular blockade after surgery. METHODS: A total of 101,510 adults undergoing noncardiac surgery under general anesthesia from October 2005 to December 2018 at a tertiary care center in Massachusetts were analyzed for the primary outcome of postoperative respiratory complications (invasive mechanical ventilation requirement within 7 postoperative days or immediate postextubation desaturation [oxygen saturation {Spo2} <90%] within 10 minutes). The primary objective was to assess the association between the REPS and respiratory complications. The secondary objective was to compare REPS and train-of-four (TOF) ratio <0.90 on the strength of their association with respiratory complications. RESULTS: A high REPS (≥4) was associated with an increase in odds of respiratory complications (adjusted odds ratio [OR], 1.13 [95% confidence interval {CI}, 1.06-1.21]; P <.001). In 6224 cases with available TOF ratio measurements, a low TOF ratio (<0.9) was associated with respiratory complications (adjusted OR, 1.43 [95% CI, 1.11-1.85]; P =.006), whereas a high REPS was not (adjusted OR, 0.96 [95% CI, 0.74-1.23]; P =.73) (P =.018 for comparison between ORs). CONCLUSIONS: The REPS may be implemented as a screening tool to encourage clinicians to use quantitative neuromuscular monitoring in patients at risk of residual neuromuscular blockade. A positive REPS should be followed by a quantitative assessment of the TOF ratio.
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U2 - 10.1213/ANE.0000000000005363
DO - 10.1213/ANE.0000000000005363
M3 - Article
C2 - 33497061
AN - SCOPUS:85113142652
VL - 133
SP - 610
EP - 619
JO - Anesthesia and Analgesia
JF - Anesthesia and Analgesia
SN - 0003-2999
IS - 3
ER -