Article of the Month
Dear colleagues and airway enthusiast
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 study, Lancet Respir Med. 2019 Feb;7(2):129-140