Risk factors for postoperative residual neuromuscular blockade in patients undergoing thoracic surgery / 中华麻醉学杂志

ABSTRACT

Objective To screen the risk factors for postoperative residual neuromuscular blockade (RNMB) in the patients undergoing thoracic surgery.Methods A total of 733 patients undergoing elective thoracic surgery with general anesthesia,without neuromuscular disease,skin temperature ≥32 ℃,were transferred to the postanesthesia care unit (PACU) after surgery and given synchronized intermittent mandatory ventilation.Neuromuscular blockade was monitored immediately after admission to the PACU,and the occurrence of postoperative RNMB was defined as a train of four (TOF) ratio ＜90％ at the time of extubation.The patients were divided into RNMB group and nonRNMB group according to whether or not postoperative RNMB occurred.Each parameter of baseline patient characteristics,complications,sites and methods of surgery,anesthesia time,requirement for muscle relaxants during surgery,TOF ratio on arrival to the PACU,requirement for muscle relaxant antagonists in the PACU,and extubation time were recorded.The risk factors of which P values were less than 0.05 would enter the multivariable logistic regression analysis to stratify the risk factors for postoperative RNMB.Results A total of 385 patients developed postoperative RNMB,and the incidence was 52.5％.The results of multivariate logistic regression analysis showed that complications such as diabetes,intraoperative application of two kinds of muscle relaxants,average intraoperative consumption of cisatracurium ≥ 0.14 mg · kg-1 · h-1,TOF ratio on arrival to the PACU ≤ 0.5,and extubation time ≤ 30 min were independent risk factors for postoperative RNMB (P＜0.05).Conclusion Complications such as diabetes,intraoperative application of two kinds of muscle relaxants,average intraoperative consumption of cisatracurium 0.14 mg · kg-1 · h-1,TOF ratio on arrival to the PACU ≤ 0.5,and extubation time ≤ 30 min are independent risk factors for postoperative RNMB in the patients undergoing thoracic surgery.