Neostigmine reversal doesn't improve postoperative respiratory safety

We recently reported an association between the intraoperative administration of intermediate acting non-depolarizing neuromuscular blocking agents and severe postoperative respiratory complications (oxygen desaturation, reintubation, and unplanned admission to intensive care).1 In secondary analyses we examined standard techniques to abate the effects of postoperative residual neuromuscular blockade—neostigmine administration and neuromuscular transmission monitoring. We found that their use did not reduce the risk of respiratory outcomes.In the main and secondary analyses we used propensity score matching to control for confounding factors associated with the use of neuromuscular blocking agents. However, our methods did not account for confounding factors related to the use of neostigmine.We conducted additional analyses to evaluate whether these recommended strategies to reduce the risk of residual neuromuscular blockade help …