eISSN: 1731-2531
ISSN: 1642-5758
Anaesthesiology Intensive Therapy
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4/2021
vol. 53
 
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abstract:
Original paper

Identifying high dose neostigmine as a risk factor for post-operative respiratory complications: a case-control study

Shreya Ranjan
1
,
Robert R. Hall III
1
,
Mohammed Al-Zarah
1
,
Sadeq A. Quraishi
1
,
Dan M. Drzymalski
1

1.
Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
Anaesthesiol Intensive Ther 2021; 53, 4: 325–328
Online publish date: 2021/09/28
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Introduction
Neostigmine, an acetylcholinesterase inhibitor, is used to reverse the effects of non-depolarizing neuromuscular blocking agents. Inappropriate dosing of neostigmine can lead to post-operative respiratory complications. Post-operative respiratory complications are associated with major morbidity and mortality. The purpose of this case-control study was to determine neuromuscular blockade-related risk factors associated with post-operative respiratory complications (specifically, reintubation, respiratory insufficiency, hypoxia, and/or aspiration).

Material and methods
We performed an Institutional Review Board-approved case-control study of all patients who underwent a general anesthetic requiring neuromuscular blockade at Tufts Medical Center between March 22, 2013 and June 1, 2019. Cases were patients who experienced post-operative complications. We identified 58 controls and 116 cases from a database of 130,178 patients during the 74-month study period.

Results
After adjusting for covariates, the administration of high dose neostigmine (> 60 mg per kg ideal body weight) was associated with increased odds of post-operative respiratory complications (odds ratio = 8.2; 95% CI: 2.5–26.6, P < 0.001). Rocuronium dose and the use of train-of-four peripheral nerve stimulator were not associated with post-operative respiratory complications.

Conclusions
High dose neostigmine was identified as an independent risk factor for post-operative respiratory complications. Our study suggests that inappropriate dosing of neostigmine continues to be a problem despite growing evidence of an association with respiratory complications.

keywords:

respiratory complications, neostigmine, reintubation

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