Bibliographie Clémence Le Tanneur en ligne article et diaporama en ligne

pour sa Bibliographie, Clémence Le Tanneur , interne dans le service nous présentera une analyse d’un article du BMJ 2012 de Martina Grosse-Sundrup et coll. sur les complications post-opératoires de l’utilisation des curares avec ou sans décurarisation

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Afin de préparer notre discussion, Vous pouvez consulter ci-après l’abstract de cet article :

BMJ. 2012 Oct 15 ;345:e6329. doi : 10.1136/bmj.e6329.

Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications : prospective propensity score matched cohort study.

Grosse-Sundrup M, Henneman JP, Sandberg WS, Bateman BT, Uribe JV, Nguyen NT,
Ehrenfeld JM, Martinez EA, Kurth T, Eikermann M.

Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston, 02114, USA.

OBJECTIVE :

To determine whether use of intermediate acting neuromuscular blocking agents during general anesthesia increases the incidence of postoperative respiratory complications.
DESIGN :

Prospective, propensity score matched cohort study.
SETTING :

General teaching hospital in Boston, Massachusetts, United States, 2006-10.

PARTICIPANTS :

18,579 surgical patients who received intermediate acting neuromuscular blocking agents during surgery were matched by propensity score to 18,579 reference patients who did not receive such agents.
MAIN OUTCOME MEASURES :

The main outcome measures were oxygen desaturation after extubation (hemoglobin oxygen saturation <90% with a decrease in oxygen saturation after extubation of >3%) and reintubations requiring unplanned admission to an intensive care unit within seven days of surgery. We also evaluated effects on these outcome variables of qualitative monitoring of neuromuscular transmission (train-of-four ratio) and reversal of neuromuscular blockade with neostigmine to prevent residual postoperative neuromuscular blockade.

RESULTS :

The use of intermediate acting neuromuscular blocking agents was associated with an increased risk of postoperative desaturation less than 90% after extubation (odds ratio 1.36, 95% confidence interval 1.23 to 1.51) and reintubation requiring unplanned admission to an intensive care unit (1.40, 1.09 to 1.80). Qualitative monitoring of neuromuscular transmission did not decrease this risk and neostigmine reversal increased the risk of postoperative desaturation less than 90% (1.32, 1.20 to 1.46) and reintubation (1.76, 1.38 to 2.26).

CONCLUSION :

The use of intermediate acting neuromuscular blocking agents during anesthesia was associated with an increased risk of clinically meaningful respiratory complications. Our data suggest that the strategies used in our trial to prevent residual postoperative neuromuscular blockade should be revisited.