Article of the Month


Dear colleagues and airway enthusiast 
The European Airway Management Society is introducing a new feature – Article of the Month. 
This is designed to provide an opportunity to our members to highlight and share airway related topics and to open discussion forums in order to share clinical experience for the benefit of all EAMS members. 
The Article of the Month will be made available via the EAMS website and is going to be accompanied by a short text (up to 200 words) explaining why is this article being selected. 
EAMS members with login to will have access to the articles as full-text PDF's.
We would like to encourage our members to propose articles of the month. The short text accompanying the article will also be made available on line with full acknowledgement of the author who proposed the article. 
The final decision to go on-line will be taken by the EAMS Board of Directors. 

Best regards 
R. Tino Greif 
President of the European Airway Management Society


Dear airway enthusiasts,

This month's article is from Arnd Timmermann. In this very large multicentre, prospective observational cohort study including almost 250000 patients from more than 200 hospitals from 28 European countries the authors could demonstrate that the use of neuromuscular blocking agents (NMBA) in general anaesthesia was associated with an increased risk of postoperative pulmonary complications. Interestingly, this was more evident in patients with ASA status I or II. Nor the use of qualitative or quantitative neuromuscular monitoring or the use of reversal agents could reduce the risk of postoperative pulmonary complications.

They concluded that Anaesthetists must balance the potential benefits of NMBA´s against the increased risk of postoperative pulmonary complications.

The reader must know that it is not clear if these increased pulmonary complication rate are due the use of NMBA´s or the use of the endotracheal tube, since the airway of the group who has received no NMBA were almost all managed by the use of supraglottic airway devices. 

The article adds to the knowledge that the use of SGA in general anesthesia should be considered as the first line airway management strategy whenever feasible.


Kirmeier E, Eriksson LI, Lewald H, Jonsson Fagerlund M, Hoeft A, Hollmann M, Meistelman C, Hunter JM, Ulm K, Blobner M; POPULAR Contributors:  Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational studyLancet Respir Med. 2019 Feb;7(2):129-140


#1 Michael Seltz Kristensen 2019-03-28 08:08
Thanks to Arnd for giving us the article of the month March 2019

Comments to the study:
It is a pure observational study, and the anaesthesiologi sts used NMBA when they found it indicated. Overall NMBA was used in 17150/21694 = 79 % of patients. In the category of patients for upper abdominal surgery and lower open abdominal surgery NMBA was used in 5688/6040 = 94% of cases – so NMBA was more often used in the high-risk groups – so no wonder that use of NMBA was ASSOCIATED with higher rate of pulmonary complications.
As the authors admit, this study only shows association – NOT CAUSATION.
So, this study does not allow conclusions about if it better or worse to use NMBA – and certainly does not allow any conclusion regarding what is best, tubes or supraglottic airways.
– So, let’s keep in mind what we learned from NAP4: That supraglottic airways used in-appropriatel y may lead to fatal aspiration.


Michael Seltz Kristensen

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