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Effects of high neuromuscular blocking agent dose on post‐operative respiratory complications in infants and children
Author(s) -
Scheffenbichler Flora T.,
Rudolph Maíra I.,
Friedrich Sabine,
Althoff Friederike C.,
Xu Xinling,
Spicer Aaron C.,
Patrocínio Maria,
Ng Pauline Y.,
Deng Hao,
Anderson Thomas A.,
Eikermann Matthias
Publication year - 2020
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13478
Subject(s) - medicine , confounding , neuromuscular blocking agents , anesthesia , odds ratio , respiratory system
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.