Risk factors for postoperative residual paralysis in patients undergoing general anesthesia / 中华麻醉学杂志

ABSTRACT

Objective To determine the risk factors for postoperative residual paralysis in patients undergoing general anesthesia and establish the warning score system initially.Methods A total of 369 patients who underwent general anesthesia and developed residual paralysis after returning to the recovery room and 740 patients who did not developed residual paralysis were enrolled in the study.Logistic regression was used to analyze the factors of which P values were less than 0.05 to identify the independent risk factors for postoperative residual paralysis.The warning score system was established initially according to the odds ratios of each risk factor,and the area under receiver operating characteristic curve was used to evaluate the predicting ability of the system.Results Logistic regression analysis showed that the consumption of cisatracurium more than 0.4 mg · kg-1 · h-1,time from the last administration of muscle relaxants to the end of operation less than 60 min and volume of intraoperative fluid infused more than 20 ml/kg were independent risk factors for postoperative residual paralysis in patients undergoing general anesthesia.The warning score system of residual paralysis was established initially,and the area under receiver operating characteristic curve was 0.82.The best cut-off value of predicting residual paralysis was 1.5 (sensitivity 63.5％,specificity 82.7％,Youden index 0.462),and thus the risk stratification criteria were determined initially with score less than or equal to 1 predicting low risk,and score more than or equal to 2 predicting high risk.Conclusion The consumption of cisatracurium more than 0.4 mg · kg-1 · h-1,time from the last administration of muscle relaxants to the end of operation less than 60 min and volume of intraoperative fluid infused more than 20 ml/kg are independent risk factors for postoperative residual paralysis in patients undergoing general anesthesia;the initially established warning score system produces higher accuracy in predicting postoperative residual paralysis.