Epidemiology and outcomes of residual neuromuscular blockade: A systematic review of observational studies
Complete reversal of neuromuscular blockade (NMB) is important for patient safety and prognosis following surgical procedures involving NMB agents (NMBAs). Published evidence on the epidemiology and consequences of residual neuromuscular blockade (rNMB; incomplete neuromuscular recovery) in real-wor...
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| Veröffentlicht in: | Journal of clinical anesthesia 2020-11, Vol.66, p.109962-109962, Article 109962 |
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| creator | Raval, Amit D. Anupindi, Vamshi Ruthwik Ferrufino, Cheryl P. Arper, Diana L. Bash, Lori D. Brull, Sorin J. |
| description | Complete reversal of neuromuscular blockade (NMB) is important for patient safety and prognosis following surgical procedures involving NMB agents (NMBAs). Published evidence on the epidemiology and consequences of residual neuromuscular blockade (rNMB; incomplete neuromuscular recovery) in real-world clinical settings is lacking with advances in NMB management. Therefore, we aimed to examine the burden of rNMB and its associated clinical, economic and humanistic outcomes using a systematic review framework.
Electronic and conference database searches were performed to include observational studies examining rNMB or related outcomes in adults undergoing surgery and receiving NMBAs with or without NMBA antagonists.
Of 1438 screened abstracts, 58 studies with 25,277 total patients were included. Inconsistent definitions of rNMB were reported across studies with 44 (76%) and 29 (50%) studies utilizing quantitative and qualitative measures to detect rNMB, respectively. The most common definition of rNMB was train-of-four ratio (TOFR) |
| doi_str_mv | 10.1016/j.jclinane.2020.109962 |
| format | Article |
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Electronic and conference database searches were performed to include observational studies examining rNMB or related outcomes in adults undergoing surgery and receiving NMBAs with or without NMBA antagonists.
Of 1438 screened abstracts, 58 studies with 25,277 total patients were included. Inconsistent definitions of rNMB were reported across studies with 44 (76%) and 29 (50%) studies utilizing quantitative and qualitative measures to detect rNMB, respectively. The most common definition of rNMB was train-of-four ratio (TOFR) <0.9 (29 studies) and TOFR <0.7 (16 studies) measured at post-anesthesia care unit (PACU) entry. For TOFR <0.9 at PACU entry, rNMB incidence ranged from 0% to 90.5% (median 30%) overall; 0% to 16.0% in the sugammadex (SUG) group; 3.5% to 90.5% in the neostigmine (NEO) group; and 15% to 89% in the spontaneous recovery (SR) group. Twenty-one studies reported clinical outcomes (reintubation, mild hypoxemia, or a respiratory event) or resource utilization outcomes (hospital/PACU length of stay [LOS]) by presence/absence of rNMB. Patients with rNMB had higher rates of acute respiratory events compared to those without rNMB.
Real-world observational studies show a significant burden of rNMB and associated health sequelae, though rNMB measures were not reported consistently across studies. Appropriate quantitative measurement is needed to accurately identify rNMB, and interventions are needed to reduce its burden and associated adverse outcomes.
•Of 58 studies, rNMB by qualitative and quantitative measures was 0% to 80%, varying widely across NMB management approaches•Qualitative measures of rNMB are used despite poor accuracy, resulting in higher variability in reported rNMB complications•Review of literature shows the need for standard definitions and methods for reporting rNMB to accurately assess its burden</description><identifier>ISSN: 0952-8180</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/j.jclinane.2020.109962</identifier><identifier>PMID: 32585565</identifier><language>eng</language><publisher>NEW YORK: Elsevier Inc</publisher><subject>Anesthesia ; Anesthesiology ; Clinical trials ; Intubation ; Life Sciences & Biomedicine ; Neuromuscular blockade ; Observational studies ; Patients ; Real-world evidence ; Residual neuromuscular block ; Science & Technology ; Sugammadex ; Surgery ; Systematic literature review ; Systematic review</subject><ispartof>Journal of clinical anesthesia, 2020-11, Vol.66, p.109962-109962, Article 109962</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><rights>2020. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>22</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000576787400018</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c396t-1eafa9c43ba62b9351b4d7970b28eb8f36f918665b3e5fe5348850d2a7c8d92b3</citedby><cites>FETCH-LOGICAL-c396t-1eafa9c43ba62b9351b4d7970b28eb8f36f918665b3e5fe5348850d2a7c8d92b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2445352331?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,28253,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32585565$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Raval, Amit D.</creatorcontrib><creatorcontrib>Anupindi, Vamshi Ruthwik</creatorcontrib><creatorcontrib>Ferrufino, Cheryl P.</creatorcontrib><creatorcontrib>Arper, Diana L.</creatorcontrib><creatorcontrib>Bash, Lori D.</creatorcontrib><creatorcontrib>Brull, Sorin J.</creatorcontrib><title>Epidemiology and outcomes of residual neuromuscular blockade: A systematic review of observational studies</title><title>Journal of clinical anesthesia</title><addtitle>J CLIN ANESTH</addtitle><addtitle>J Clin Anesth</addtitle><description>Complete reversal of neuromuscular blockade (NMB) is important for patient safety and prognosis following surgical procedures involving NMB agents (NMBAs). Published evidence on the epidemiology and consequences of residual neuromuscular blockade (rNMB; incomplete neuromuscular recovery) in real-world clinical settings is lacking with advances in NMB management. Therefore, we aimed to examine the burden of rNMB and its associated clinical, economic and humanistic outcomes using a systematic review framework.
Electronic and conference database searches were performed to include observational studies examining rNMB or related outcomes in adults undergoing surgery and receiving NMBAs with or without NMBA antagonists.
Of 1438 screened abstracts, 58 studies with 25,277 total patients were included. Inconsistent definitions of rNMB were reported across studies with 44 (76%) and 29 (50%) studies utilizing quantitative and qualitative measures to detect rNMB, respectively. The most common definition of rNMB was train-of-four ratio (TOFR) <0.9 (29 studies) and TOFR <0.7 (16 studies) measured at post-anesthesia care unit (PACU) entry. For TOFR <0.9 at PACU entry, rNMB incidence ranged from 0% to 90.5% (median 30%) overall; 0% to 16.0% in the sugammadex (SUG) group; 3.5% to 90.5% in the neostigmine (NEO) group; and 15% to 89% in the spontaneous recovery (SR) group. Twenty-one studies reported clinical outcomes (reintubation, mild hypoxemia, or a respiratory event) or resource utilization outcomes (hospital/PACU length of stay [LOS]) by presence/absence of rNMB. Patients with rNMB had higher rates of acute respiratory events compared to those without rNMB.
Real-world observational studies show a significant burden of rNMB and associated health sequelae, though rNMB measures were not reported consistently across studies. Appropriate quantitative measurement is needed to accurately identify rNMB, and interventions are needed to reduce its burden and associated adverse outcomes.
•Of 58 studies, rNMB by qualitative and quantitative measures was 0% to 80%, varying widely across NMB management approaches•Qualitative measures of rNMB are used despite poor accuracy, resulting in higher variability in reported rNMB complications•Review of literature shows the need for standard definitions and methods for reporting rNMB to accurately assess its burden</description><subject>Anesthesia</subject><subject>Anesthesiology</subject><subject>Clinical trials</subject><subject>Intubation</subject><subject>Life Sciences & Biomedicine</subject><subject>Neuromuscular blockade</subject><subject>Observational studies</subject><subject>Patients</subject><subject>Real-world evidence</subject><subject>Residual neuromuscular block</subject><subject>Science & Technology</subject><subject>Sugammadex</subject><subject>Surgery</subject><subject>Systematic literature review</subject><subject>Systematic review</subject><issn>0952-8180</issn><issn>1873-4529</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkctu1DAYhSMEokPhFapIbJBQBl9ix2ZFNSoXqRIbWFu-_EEOSTzYcat5exwy7YINrGzZ3_fLPqeqrjDaY4T5u2E_2NHPeoY9QWQ9lJKTJ9UOi442LSPyabVDkpFGYIEuqhcpDQihcoGfVxeUMMEYZ7tquDl6B5MPY_hxqvXs6pAXGyZIdejrCMm7rMd6hhzDlJPNo461GYP9qR28r6_rdEoLTHrxttB3Hu5XL5gE8a4chrnIacnOQ3pZPev1mODVeb2svn-8-Xb43Nx-_fTlcH3bWCr50mDQvZa2pUZzYiRl2LSukx0yRIARPeW9xIJzZiiwHhhthWDIEd1Z4SQx9LJ6s809xvArQ1rU5JOFcSxhhZwUabHAFNFWFvT1X-gQcixvXqmWUUYoxYXiG2VjSClCr47RTzqeFEZqbUMN6qENtbahtjaKeHUen80E7lF7iL8AbzfgHkzok_UwW3jESl-s453o2rLDotDi_-mDX_7kfwh5Xor6YVOhBF9aiuqsOx_BLsoF_6_P_AbD9sCQ</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Raval, Amit D.</creator><creator>Anupindi, Vamshi Ruthwik</creator><creator>Ferrufino, Cheryl P.</creator><creator>Arper, Diana L.</creator><creator>Bash, Lori D.</creator><creator>Brull, Sorin J.</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202011</creationdate><title>Epidemiology and outcomes of residual neuromuscular blockade: A systematic review of observational studies</title><author>Raval, Amit D. ; 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Published evidence on the epidemiology and consequences of residual neuromuscular blockade (rNMB; incomplete neuromuscular recovery) in real-world clinical settings is lacking with advances in NMB management. Therefore, we aimed to examine the burden of rNMB and its associated clinical, economic and humanistic outcomes using a systematic review framework.
Electronic and conference database searches were performed to include observational studies examining rNMB or related outcomes in adults undergoing surgery and receiving NMBAs with or without NMBA antagonists.
Of 1438 screened abstracts, 58 studies with 25,277 total patients were included. Inconsistent definitions of rNMB were reported across studies with 44 (76%) and 29 (50%) studies utilizing quantitative and qualitative measures to detect rNMB, respectively. The most common definition of rNMB was train-of-four ratio (TOFR) <0.9 (29 studies) and TOFR <0.7 (16 studies) measured at post-anesthesia care unit (PACU) entry. For TOFR <0.9 at PACU entry, rNMB incidence ranged from 0% to 90.5% (median 30%) overall; 0% to 16.0% in the sugammadex (SUG) group; 3.5% to 90.5% in the neostigmine (NEO) group; and 15% to 89% in the spontaneous recovery (SR) group. Twenty-one studies reported clinical outcomes (reintubation, mild hypoxemia, or a respiratory event) or resource utilization outcomes (hospital/PACU length of stay [LOS]) by presence/absence of rNMB. Patients with rNMB had higher rates of acute respiratory events compared to those without rNMB.
Real-world observational studies show a significant burden of rNMB and associated health sequelae, though rNMB measures were not reported consistently across studies. Appropriate quantitative measurement is needed to accurately identify rNMB, and interventions are needed to reduce its burden and associated adverse outcomes.
•Of 58 studies, rNMB by qualitative and quantitative measures was 0% to 80%, varying widely across NMB management approaches•Qualitative measures of rNMB are used despite poor accuracy, resulting in higher variability in reported rNMB complications•Review of literature shows the need for standard definitions and methods for reporting rNMB to accurately assess its burden</abstract><cop>NEW YORK</cop><pub>Elsevier Inc</pub><pmid>32585565</pmid><doi>10.1016/j.jclinane.2020.109962</doi><tpages>8</tpages></addata></record> |
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| subjects | Anesthesia Anesthesiology Clinical trials Intubation Life Sciences & Biomedicine Neuromuscular blockade Observational studies Patients Real-world evidence Residual neuromuscular block Science & Technology Sugammadex Surgery Systematic literature review Systematic review |
| title | Epidemiology and outcomes of residual neuromuscular blockade: A systematic review of observational studies |
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