Format

Send to

Choose Destination
Lancet Respir Med. 2019 Feb;7(2):129-140. doi: 10.1016/S2213-2600(18)30294-7. Epub 2018 Sep 14.

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study.

Collaborators (857)

Abad Gurumeta A, Abernethy C, Abigail P, Achaibar K, Adam E, Afshari A, Agudelo Montoya ME, Akgün FN, Aletti G, Alkış N, Allan K, Allan A, Allaouchiche B, Allcock C, Almasy E, Amey I, Amigoni M, Andersen E, Andersson P, Anipchenko N, Antunes P, Armstrong E, Aslam TN, Aslin B, Assunção JP, Ausserer J, Avvai M, Awad N, Ayas Montero B, Ayuso M, Azevedo P, Badarau V, Badescu R, Baiardo Redaelli M, Baird C, Baird Y, Baker T, Balaji P, Bălan C, Balandin A, Balescu-Arion C, Baliuliene V, Baltasar Isabel J, Baluch SN, Bandrabur D, Bankewitz C, Barber K, Barbera F, Barcraft-Barnes H, Barletti V, Barnett G, Baron K, Barros A, Barsan V, Bartlett P, Batistaki C, Baumgarten G, Baytas V, Beauchamp N, Becerra Cayetano IA, Bell S, Bellandi M, Belletti A, Belmonte Cuenca J, Benitez-Cano A, Beretta L, Berger M, Bergmann N, Bergmark K, Bermudez Lopez M, Bernotaite M, Beurskens C, Bidd H, Bifulco F, Bignami E, Bilic A, Bilskiene D, Bischoff P, Bishop L, Bjonness T, Blaylock H, Blethyn K, Blincoe T, Blokhin I, Blunt N, Boer C, Bois G, Bonicolini E, Booth J, Borecka-Kedzierska M, Borstnar K, Borys M, Boselli E, Bouvet L, Bouwman A, Bowen L, Bowrey S, Boxall L, Božić T, Bradley T, Branco T, Brazzi L, Brazzoni M, Brear T, Brogly N, Brohi F, Broms J, Bubliauskas A, Bucolo GE, Buerkle H, Buggy D, Buhre W, Bukauskas T, Butturini F, Byttner A, Cabrera Díaz I, Calderon A, Calhau R, Callejo A, Cammu G, Campesato M, Can ÖS, Candeias M, Cantor A, Carise E, Carmona C, Carreteiro J, Carrieri C, Carter A, Casal M, Casanova I, Cascella M, Casero LM, Casiraghi GM, Castelo-Branco L, Castro Arranz C, Cernea DD, Cervantes J, Chandler B, Charnock R, Chatzimicali A, Chinery E, Chishti A, Chondhury P, Christie E, Christodoudiles G, Ciardo S, Cimpeanu L, Cindea I, Cinnella G, Clark S, Clayton M, Cocu S, Collyer T, Colvin C, Cope S, Copeta F, Copotoiu SM, Correia de Barros F, Corso RM, Cortegiani A, Costa G, Cowton A, Cox N, Craig J, Cricca V, Cronin J, Cunha M, Cuomo A, Curley K, Czuczwar M, Dabrowska D, Damster S, Danguy des Déserts M, Daniliuc A, Danninger T, Darwish I, Dascalu C, Davies K, Davies S, De Boer H, De Flaviis A, De Selincourt G, Deana C, Debaene B, Debreceni G, Dedhia J, Delgado Garcia I, Della Rocca G, Delroy-Buelles L, Desai T, Dhillon P, Di Giacinto I, Di Mauro P, Diaz Gomez TV, Dimitrovski A, Dinic V, Dîrzu DS, Divander MB, Dolinar J, Domingues S, Doolan J, Downes C, Dragoescu NA, Droc G, Dum E, Dumitrescu A, Duncan L, Dzurňáková P, Eberl S, Edwards J, Edwards M, Ekelund K, Ekengren P, Elghouty E, Ellerkmann R, Ellis H, Elme A, Ernst T, Errando CL, Estenes S, Ewaldsson C, Farid N, Featherstone J, Febres D, Fedorov S, Feggeler J, Feijten P, Fellmann T, Fernandez Candil J, Fernandez Castineira A, Fernández Castineira J, Fernando A, Ferrando C, Ferreira L, Ferreira P, Feyling A, Filipescu D, Fleischer A, Floris L, Foerster U, Fox B, Franke U, Frasca D, Frey C, Frost V, Fullin G, Fumagalli J, Furneval J, Fusari M, Gallacher S, Galushka S, Gambale G, Gambino I, Garcia-Perez ML, Garg S, Garlak J, Gavranovic Z, Gavrilov R, Gaynor L, Gecaj Gashi A, Georghiou M, Gerjevic B, Gferer G, Giarratano A, Gibson A, Gievski V, Giles J, Gillberg L, Gilowska K, Gilsanz Rodriguez F, Gioia A, Giovannoni C, Girotra V, Gkinas D, Gkiokas G, Godoroja D, Goebel U, Goel V, Gonzalez M, Goranovic T, Gornik-Wlaszczuk E, Gosavi S, Gottfridsson P, Gottschalk A, Granell M, Granstrom A, Grassetto A, Greenwood A, Grigoras I, Grintescu I, Gritsan A, Gritsan G, Grynyuk A, Guadagnin GM, Guarnieri M, Güçlü Ç, Guerrero Diez M, Gunenc F, Günther U, Gupta P, Guttenthaler V, Hack Y, Hafisayena A, Hagau N, Haldar J, Hales D, Hancı V, Hanna-Jumma S, Harazim H, Harlet P, Harper D, Harris B, Harvey O, Hashimi M, Hawkins L, Hayes C, Heaton J, Heier T, Helliwell L, Hemmes S, Henderson K, Hermanides J, Hermanns H, Herrera Hueso B, Hestenes S, Hettiarachchi R, Highgate J, Hodgson K, Hoelbling D, Holland J, Horhota L, Hormis A, Hribar R, Hua A, Humphreys S, Humphries R, Humpliková S, Hunt J, Husnain A, Hussein A, Hyams B, Iannuccelli F, Ilette K, Ilyas C, Inan T, India I, Ionițăv V, Irwin F, Jain V, Janez B, Jankovic R, Jenkins S, Jenko M, Jimenez R, Jiménez Gomez B, Joachim S, Joelsson-Alm E, John J, Jonikaite L, Jovic M, Jungwirth B, Junke E, Kabakov B, Kadaoui SD, Kanski A, Karadag S, Karbonskiene A, Karjagin J, Kasnik D, Katanolli F, Katsika E, Kaufmann K, Keane H, Kelly M, Kent M, Keraitiene G, Khudhur A, Khuenl-Brady K, Kidd L, King S, Kirchgäßner K, Klancir T, Klucniks A, Knotzer J, Knowlden P, Koers L, Kompan J, Koneti KK, Kooij F, Koolen E, Koopman-van Gemert AWMM, Kopp K, Korfiotis D, Korolkov O, Kosinová M, Köstenberger M, Kotzinger O, Kovačević M, Kranke P, Kranke E, Kraus C, Kraus S, Kubitzek C, Kucharski R, Kucukguclu S, Kudrashou A, Kumar V, Kummen L, Kunit C, Kushakovsky V, Kuvaki B, Kuzmanovska B, Kyttari A, Landoni G, Lau G, Lazarev K, Legett S, Legrottaglie AM, Leonardi S, Leong M, Lercher H, Leuvrey M, Leva B, Levstek M, Limb J, Lindholm E, Linton F, Liperi C, Lipski F, Lirk P, Lisi A, Lišková K, Lluch Oltra A, Loganathan V, Lombardi S, Lopez E, Lopez Rodríguez M, Lorenzini L, Lowicka M, Lugovoy A, Luippold M, Lumb A, Macas A, Macgregor M, Machado H, Maciariello M, Madeira I, Maitan S, Majewski J, Maldini B, Malewski G, Manfredini L, Männer O, Marchand B, Marcu A, Margalef J, Margarson M, Marinheiro L, Markic A, Markovic Bozic J, Marrazzo F, Martin J, Martin Ayuso M, Martinez E, Martino EA, Martinson V, Marusic-Gaser K, Mascarenhas C, Mathis C, Matsota P, Mavrommati E, Mazul Sunko B, McCourt K, McGill N, McKee R, Meço BC, Meier S, Melbourne S, Melbybråthen G, Meli A, Melia A, Melotti RM, Menga MR, Mercer P, Merotra S, Mescolini S, Metterlein T, Michalov M, Michlig S, Midgley S, Milić M, Milojevic M, Miñana A, Minto G, Mirabella L, Mirea L, Mittelstädt L, Moeglen A, Moise A, Mokini Z, Molin A, Moltó L, Monea MC, Montalto F, Montgomery J, Montgomery C, Montillo G, Moore S, Moore F, Moreira Z, Moreno T, Moreno R, Moret E, Moreton S, Morgan M, Moro Velasco C, Morri D, Moull A, Moura F, Mráz P, Mrozek K, Mukhtar K, Muniyappa S, Murray H, Murthy BV, Mushambi M, Nadolski M, Nardelli P, Nardin G, Navarro Pérez R, Naveiro A, Negri M, Nesek Adam V, Neskovic V, Neuwersch S, Neves M, Nguyen B, Ní Eochagáin A, Nicholas C, Nightingale J, Norrie K, Novak-Jankovic V, Novakova A, Novillo M, Numan S, Oduro-Dominah L, Oldner A, Oliveira I, Ologoiu D, Oloktsidou I, O'Reilly R, Orlando A, Ovezov A, Ozbilgin S, Paal P, Padin Barreiro L, Palugniok R, Papaioannou A, Papapostolou K, Paranthaman P, Pardey Bracho G, Parente S, Parfeni A, Pasin L, Passey S, Pastor E, Patch S, Patil A, Paunescu MA, Pehboeck D, Pereira M, Pereira C, Perez Caballero P, Pérez García A, Pérez Soto A, Perez Tejero G, Perez-Cerda F, Pesenti A, Petta R, Philippe S, Pickering D, Pico Veloso J, Pina P, Pinho-Oliveira V, Pinol S, Pinto R, Pistidda L, Pitterle M, Piwowarczyk P, Plotnikova O, Pohl H, Poldermann J, Polkovicová L, Pompei L, Popescu M, Popović R, Pota V, Potocnik M, Potręć B, Potter A, Pramod N, Prchalova M, Preckel B, Pugh R, Pulletz M, Radoeshki A, Rafi A, Ragazzi R, Raineri Santi M, Rajamanickam T, Rajput Z, Ramachandran R, Ramasamy R, Ramessur S, Rao R, Rasmussen A, Rato A, Razaque U, Real Navacerrada MI, Reavley C, Reid J, Reschreiter H, Rial E, Ribas Carrasco P, Ribeiro S, Rich N, Richardson L, Rimaitis K, Rimaitis M, Ringvold EM, Ripke F, Ristescu I, Ritchie K, Ródenas F, Rodrigues P, Rogers E, Rogerson D, Romagnoli S, Romero E, Rondovic G, Rose BO, Roth W, Rotter MT, Rousseau G, Rudjord A, Rueffert H, Rundgren M, Rupprecht K, Rushton A, Russotto V, Rypulak E, Ryszka M, Sà J, Sà Couto P, Saby S, Sagic J, Saleh O, Sales G, Sánchez Sánchez Y, Sanghera S, Şanli Karip C, Santiveri Papiol FJ, Santos S, Sarno S, Saul D, Saunders D, Savic N, Scalco L, Scanlon D, Schaller S, Schax C, Scheffer GJ, Schening A, Schiavone V, Schmidt-Ehrenberg F, Schmidt-Mutter C, Schönberg C, Schopflin C, Schreiber JU, Schultz M, Schurig M, Scott C, Sebestian S, Sehgal S, Sem V, Semenas E, Serafini E, Serchan P, Shields M, Shobha R, Shosholcheva M, Siamansour T, Siddaiah N, Siddiqi K, Sinclair R, Singh P, Singh R, Sinha A, Sinha A, Skinner A, Smee E, Smekalova O, Smith N, Smith T, Smitz C, Smole D, Sojčić N, Soler Pedrola M, Somanath S, Sonksen J, Sorella MC, Sörmus A, Soro M, Soto C, Spada A, Spadaro S, Spaeth J, Sparr H, Spielmann A, Spindler-Vesel A, Stamelos M, Stancombe L L, Stanculescu A, Standl T, Standley T, Stanek O, Stanisavljević S, Starczewska M, Stäuble C, Steen J, Stefan OM, Stell E, Stera C, Stevens M, Stoerckel M, Stošić B, Stourac P, Stroumpoulis K, Struck R, Suarez de la Rica A, Sultanpori A, Sundara Rajan R, Suying O, Svensen C, Swan L, Syrogianni P, Sysiak J, Szederjesi J, Taddei S, Tan Hao E, Tanou V, Tarabová K, Tardaguila Sancho P, Tarroso M, Tartaglione M, Taylor E, Tbaily L, Telford R, Terenzoni M, Theodoraki K, Thornley H, Tiganiuc L, Toim H, Tomescu D, Tommasino C, Toni J, Toninelli A, Toretti I, Townley S, Trepenaitis D, Trethowan B, Tsaousi G, Tsiftsi A, Tudor A, Turan G, Turhan SÇ, Unic-Stojanovic D, Unterbuchner C, Unzueta C, Uranjek J, Ursic T, Vaida S, Valldeperas Ferrer S, Valldeperas Hernandez MI, Valsamidis D, Van Beek R, Van Dasselaer N, Van Der Beek T, Van Duivenvoorde Y, van Klei WA, Van Poorter F, Van Zaane B, Van Zundert T, Van Zyl R, Vargas Munoz AM, Varsani N, Vasconcelos P, Vassilakis G, Vecchiatini T, Vecera L, Vercauteren M, Verdouw B, Verheyen V, Verri M, Vicari Sottosanti LG, Vico M, Vidal Mitjans P, Vilardi A, Vissicchio D, Vitale G, Vitković B, Vizcaychipi MP, Voicu A, Voje M, Volfová I, Volta CA, Von Lutterotti T, von Tiesenhausen A, Vrecic-Slabe S, Vukcevic D, Vukovic R, Vullo PA, Wade A, Wallberg H, Wallden J, Wallner J, Walther Sturesson L, Watson D, Weber S, Wegiel Leskiewiq A, Weller D, Wensing C, Werkmann M, Westberg H, Wikström E, Williams B, Williams B, Wilson R, Wirth S, Wittmann M, Wood L, Wright S, Zachoval C, Zambon M, Zampieri S, Zampone S, Zangrillo A, Zani G, Zavackiene A, Zieglerder R, Zonneveldt H, Zsisku L, Zucker TP, Żukowski M, Zuleika M, Zupanĕiĕ D.

Erratum in

Abstract

BACKGROUND:

Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications.

METHODS:

We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513.

FINDINGS:

Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21 694); ORadj 1·86, 95% CI 1·53-2·26; ARRadj -4·4%, 95% CI -5·5 to -3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15-1·49; ARRadj -2·6%, 95% CI -3·9 to -1·4) and the administration of reversal agents (1·23, 1·07-1·41; -1·9%, -3·2 to -0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85-1·25; ARRadj -0·3%, 95% CI -2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82-1·31; -0·4%, -3·5 to 2·2) was associated with better pulmonary outcomes.

INTERPRETATION:

We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications.

FUNDING:

European Society of Anaesthesiology.

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center