TY - JOUR
T1 - Succinylcholine and postoperative pulmonary complications
T2 - a retrospective cohort study using registry data from two hospital networks
AU - Schaefer, Maximilian S.
AU - Hammer, Maximilian
AU - Santer, Peter
AU - Grabitz, Stephanie D.
AU - Patrocinio, Maria
AU - Althoff, Friederike C.
AU - Houle, Timothy T.
AU - Eikermann, Matthias
AU - Kienbaum, Peter
N1 - Funding Information:
MSS, MH, PS, SDG, MP, FCA and TTH declare that they have no conflicts of interest. ME is an associate editor of the British Journal of Anaesthesia. He has received funding for investigator-initiated trials not related to this manuscript from MERCK Inc., and is holding a patent for acyclic curcubiturils, a new agents to reverse NMBA. PK has been consulting for Baxter GmbH Germany, Air Liquide Medical GmbH Germany, and TEVA Ratiopharm Germany, and received lecture fees and travelling expenses from these companies. He is an associate editor of BMC Anesthesiology.Jeffrey and Judy Buzen (unrestricted grant to ME). Department of Anesthesia, Critical Care and Pain Medicine at Beth Israel Deaconess Medical Center, Boston, MA, USA (institutional funding).
Publisher Copyright:
© 2020 British Journal of Anaesthesia
PY - 2020/10
Y1 - 2020/10
N2 - Background: Neuromuscular blocking agents (NMBAs) with a non-depolarising mechanism of action carry the risk of postoperative residual paralysis and are associated with postoperative pulmonary complications (POPC). Owing to the shorter duration of action, the depolarising NMBA succinylcholine may be associated with less postoperative residual paralysis, and hence fewer POPC. We tested the association of succinylcholine administration during anaesthesia and POPC. Methods: In a retrospective cohort study of registry data from two large US academic medical centres, 244 850 adult noncardiac surgical patients undergoing general anaesthesia were included. The primary outcome was POPC, defined as post-extubation haemoglobin oxygen de-saturation to <90%, or re-intubation requiring intensive care unit admission within 7 days after surgery. The association between succinylcholine and POPC and its dose-dependency were tested in a hierarchical fashion using a multivariable logistic regression model. Results: A total of 13 206 patients (5.4%) experienced POPC. Use of succinylcholine was associated with increased risk of POPC (adjusted odds ratio [ORAdj]=1.11; 95% confidence interval [CI], 1.06–1.16; P<0.001; adjusted risk=5.18%; 95% CI, 5.06–5.30 without and 5.69%; 95% CI, 5.53–5.85 with succinylcholine), with a dose-dependent relationship (ORAdj=1.08; 95% CI, 1.05–1.11 per mg kg−1; P<0.001). In patients receiving non-depolarising NMBAs, succinylcholine further increased the risk of POPC (ORAdj=1.08; 95% CI, 1.03–1.14; P=0.001). The association between succinylcholine and POPC was modified (P=0.03 for interaction) by the duration of surgery with higher odds of POPC in patients undergoing surgeries of <2 vs ≥2 h (ORAdj=1.24; 95% CI, 1.15–1.33 and 1.05; 95% CI, 1.00–1.10, respectively). Conclusions: In contrast to our prediction, succinylcholine administration was associated with an increased risk of POPC. This association was dose-dependent and magnified in surgeries of shorter duration.
AB - Background: Neuromuscular blocking agents (NMBAs) with a non-depolarising mechanism of action carry the risk of postoperative residual paralysis and are associated with postoperative pulmonary complications (POPC). Owing to the shorter duration of action, the depolarising NMBA succinylcholine may be associated with less postoperative residual paralysis, and hence fewer POPC. We tested the association of succinylcholine administration during anaesthesia and POPC. Methods: In a retrospective cohort study of registry data from two large US academic medical centres, 244 850 adult noncardiac surgical patients undergoing general anaesthesia were included. The primary outcome was POPC, defined as post-extubation haemoglobin oxygen de-saturation to <90%, or re-intubation requiring intensive care unit admission within 7 days after surgery. The association between succinylcholine and POPC and its dose-dependency were tested in a hierarchical fashion using a multivariable logistic regression model. Results: A total of 13 206 patients (5.4%) experienced POPC. Use of succinylcholine was associated with increased risk of POPC (adjusted odds ratio [ORAdj]=1.11; 95% confidence interval [CI], 1.06–1.16; P<0.001; adjusted risk=5.18%; 95% CI, 5.06–5.30 without and 5.69%; 95% CI, 5.53–5.85 with succinylcholine), with a dose-dependent relationship (ORAdj=1.08; 95% CI, 1.05–1.11 per mg kg−1; P<0.001). In patients receiving non-depolarising NMBAs, succinylcholine further increased the risk of POPC (ORAdj=1.08; 95% CI, 1.03–1.14; P=0.001). The association between succinylcholine and POPC was modified (P=0.03 for interaction) by the duration of surgery with higher odds of POPC in patients undergoing surgeries of <2 vs ≥2 h (ORAdj=1.24; 95% CI, 1.15–1.33 and 1.05; 95% CI, 1.00–1.10, respectively). Conclusions: In contrast to our prediction, succinylcholine administration was associated with an increased risk of POPC. This association was dose-dependent and magnified in surgeries of shorter duration.
KW - dose–response relationship
KW - general anaesthesia
KW - hypoxaemia
KW - neuromuscular blocking agent
KW - respiratory failure
KW - succinylcholine
UR - http://www.scopus.com/inward/record.url?scp=85087685859&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85087685859&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2020.05.059
DO - 10.1016/j.bja.2020.05.059
M3 - Article
C2 - 32654742
AN - SCOPUS:85087685859
SN - 0007-0912
VL - 125
SP - 629
EP - 636
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 4
ER -