TY - JOUR
T1 - Comparison of a novel clinical score to estimate the risk of REsidual neuromuscular block prediction score and the last train-of-four count documented in the electronic anaesthesia record
T2 - A retrospective cohort study of electronic data on file
AU - Rudolph, Maíra I.
AU - Ng, Pauline Y.
AU - Deng, Hao
AU - Scheffenbichler, Flora T.
AU - Grabitz, Stephanie D.
AU - Wanderer, Jonathan P.
AU - Houle, Timothy T.
AU - Eikermann, Matthias
N1 - Publisher Copyright:
© 2018 European Society of Anaesthesiology. All rights reserved.
PY - 2018
Y1 - 2018
N2 - BACKGROUND Residual neuromuscular block (rNMB) after surgery is not difficult to identify if proper neuromuscular monitoring is used, but many clinicians do not use quantitative neuromuscular monitoring. OBJECTIVE The aim of this study was to develop a REsidual neuromuscular block Prediction Score (REPS) to predict postoperative rNMB and compare the predictive accuracy of the prediction score with train-of-four count (TOFC) measurement at the end of a surgical case. DESIGN Retrospective cohort study of data on file. DATA SOURCE Electronic patient data and peri-operative data on vital signs, administered medications, and train-of-four ratio (TOFR) obtained in the postoperative recovery rooms [postanaesthesia care unit (PACU)] at Massachusetts General Hospital in Boston, Massachusetts, USA. PATIENTS Quantitative TOFR measurements obtained on admission to the PACU were available from 2144 adult noncardiac surgical patients. MAIN OUTCOME MEASURE Presence of rNMB at PACU admission, defined as a TOFR of less than 0.9. RESULTS In the score development cohort (n¼2144), rNMB occurred in 432 cases (20.2%). Ten independent predictors for residual paralysis were identified and used for the score development. The final model included: hepatic failure, neurological disease, high-neostigmine dose, metastatic tumour, female sex, short time between neuromuscular blocking agent administration and extubation, aminosteroidal neuromuscular blocking agent, BMI more than 35, absence of nurse anaesthetist and having an experienced surgeon. The model discrimination by C statistics was 0.63, 95% confidence interval (0.60 to 0.66), and risk categories derived from the REPS had a higher accuracy than the last documented intra-operative TOFC for predicting rNMB (net reclassification improvement score 0.26, standard error 0.03, P < 0.001). CONCLUSION The REPS can be used to identify patients at greater risk of rNMB. This tool may inform anaesthetists better than an intra-operative TOFC and thus enable perioperative anaesthetic practices to be tailored to the patient and minimise the undesirable effects of rNMB.
AB - BACKGROUND Residual neuromuscular block (rNMB) after surgery is not difficult to identify if proper neuromuscular monitoring is used, but many clinicians do not use quantitative neuromuscular monitoring. OBJECTIVE The aim of this study was to develop a REsidual neuromuscular block Prediction Score (REPS) to predict postoperative rNMB and compare the predictive accuracy of the prediction score with train-of-four count (TOFC) measurement at the end of a surgical case. DESIGN Retrospective cohort study of data on file. DATA SOURCE Electronic patient data and peri-operative data on vital signs, administered medications, and train-of-four ratio (TOFR) obtained in the postoperative recovery rooms [postanaesthesia care unit (PACU)] at Massachusetts General Hospital in Boston, Massachusetts, USA. PATIENTS Quantitative TOFR measurements obtained on admission to the PACU were available from 2144 adult noncardiac surgical patients. MAIN OUTCOME MEASURE Presence of rNMB at PACU admission, defined as a TOFR of less than 0.9. RESULTS In the score development cohort (n¼2144), rNMB occurred in 432 cases (20.2%). Ten independent predictors for residual paralysis were identified and used for the score development. The final model included: hepatic failure, neurological disease, high-neostigmine dose, metastatic tumour, female sex, short time between neuromuscular blocking agent administration and extubation, aminosteroidal neuromuscular blocking agent, BMI more than 35, absence of nurse anaesthetist and having an experienced surgeon. The model discrimination by C statistics was 0.63, 95% confidence interval (0.60 to 0.66), and risk categories derived from the REPS had a higher accuracy than the last documented intra-operative TOFC for predicting rNMB (net reclassification improvement score 0.26, standard error 0.03, P < 0.001). CONCLUSION The REPS can be used to identify patients at greater risk of rNMB. This tool may inform anaesthetists better than an intra-operative TOFC and thus enable perioperative anaesthetic practices to be tailored to the patient and minimise the undesirable effects of rNMB.
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U2 - 10.1097/EJA.0000000000000861
DO - 10.1097/EJA.0000000000000861
M3 - Article
C2 - 30020144
AN - SCOPUS:85054389322
SN - 0265-0215
VL - 35
SP - 883
EP - 892
JO - European Journal of Anaesthesiology
JF - European Journal of Anaesthesiology
IS - 11
ER -