Association of Sugammadex or Neostigmine With Major Postoperative Pulmonary Complications in Children
Association of Sugammadex or Neostigmine With Major Postoperative Pulmonary Complications in Children
复制标题
舒更葡糖或新斯的明与儿童主要术后肺部并发症的关系
DOI：
10.1213/ane.0000000000005872
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发表时间：
2022
影响因子：
5.7
通讯作者：
J. Tobias
中科院分区：
文献类型：
--
作者：
Ralph J Beltran;Christian Mpody;O. Nafiu;J. Tobias
背景技术背景：成人患者的最新数据表明，与新斯的明相比，使用sugammadex逆转神经肌肉阻滞（NMB）可显着降低术后肺部复合并发症的风险。尽管肺部并发症在儿童中具有临床意义，但目前还没有研究探索NMB逆转在这些并发症风险中的作用。实验方法：我们使用2016年和2020年的儿科健康信息系统（PHIS）数据集进行了一项倾向评分匹配的回顾性研究。我们研究了18岁以下的儿童，他们接受了择期、住院、非心脏手术，并接受了新斯的明或sugammadex逆转肌松。我们的主要结局是术后肺部并发症，我们将其定义为术后肺炎或呼吸衰竭的发生。结果：我们的研究纳入了33，819名儿童，其中23，312名（68.9%）接受新斯的明治疗，10，507名（31.1%）接受sugammadex治疗。倾向评分匹配后（每组10，361例匹配），我们没有发现NMB逆转剂与肺部并发症发生率之间存在统计学显著相关性的证据（3.1% vs 3.1%;比值比[OR]，0.90; 95%置信区间[CI]，0.78-1.05; P = 0.19）。肺部并发症的组成部分，包括呼吸衰竭和肺炎，与NMB逆转剂的选择无统计学相关性。结论：肌松拮抗剂的选择似乎不会影响主要术后肺部并发症的发生率。还需要进一步的研究来确定我们的研究结果是否适用于由外科专业、复杂慢性病的存在和麻醉技术定义的亚群。
BACKGROUND: Recent data in adult patients indicate that the use of sugammadex compared to neostigmine for reversal of neuromuscular block (NMB) was associated with a significant reduction in the risk of composite postoperative pulmonary complications. Despite the clinical significance of pulmonary complications in children, studies exploring the role of NMB reversal in the risk of these complications are currently unavailable. METHOD: We performed a propensity score-matched retrospective study using the Pediatric Health Information System (PHIS) dataset spanning the years 2016 and 2020. We studied children <18 years who underwent elective, inpatient, noncardiac surgical procedures and received either neostigmine or sugammadex for reversal of NMB. Our primary outcome was major postoperative pulmonary complication, which we defined as the occurrence of either postoperative pneumonia or respiratory failure. RESULTS: Our study included a study population of 33,819 children, of whom 23,312 (68.9%) received neostigmine and 10,507 (31.1%) received sugammadex. After propensity score matching (10,361 matched from each group), we found no evidence of a statistically significant association between the NMB reversal agent and the incidence of pulmonary complications (3.1% vs 3.1%; odds ratio [OR], 0.90; 95% confidence interval [CI], 0.78–1.05; P = .19). The components of pulmonary complications, including respiratory failure and pneumonia, were not statistically associated with the choice of NMB reversal agent. CONCLUSIONS: Choice of NMB reversal agent does not appear to impact the incidence of major postoperative pulmonary complications. Further research is needed to determine whether our results carry forth across subpopulations defined by surgical specialty, the presence of complex chronic conditions, and anesthesia technique.