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Evaluation of Neuromuscular Blockade Reversal on Postoperative Mechanical Ventilation Time in a Cardiovascular Surgery Population.

Abstract

OBJECTIVE

To report on postoperative outcomes related to the administration of neostigmine for reversal of nondepolarizing neuromuscular blocking agents in cardiovascular surgery patients, with a specific focus on the duration of postoperative mechanical ventilation as the primary endpoint.

DESIGN

A retrospective cohort study design was followed to achieve the study objectives.

SETTING

This was a single-center, chart review study conducted at a large academic medical center of adult patients post-cardiovascular surgery.

PARTICIPANTS

Patients were included if they had received a bolus dose of perioperative nondepolarizing neuromuscular blocking agent and underwent one of the targeted cardiovascular surgeries.

INTERVENTIONS

Final analysis comprised of 175 patients, 95 of whom received neostigmine and 80 who did not receive neostigmine.

MEASUREMENTS AND MAIN RESULTS

The primary endpoint was the duration of postoperative mechanical ventilation. When controlling for all covariates, neostigmine use was associated with a 0.34-hour reduction (∼20.4 min) in duration of mechanical ventilation (parameter estimate: 0.66, 95% confidence interval 0.49-0.89; p = 0.0071). More patients who received neostigmine met the early extubation benchmark of less than 6 hours (55 v 34 patients; p = 0.04). Finally, neostigmine use was not found to be associated with increased risk of respiratory complications or postoperative nausea and/or vomiting.

CONCLUSIONS

The use of neostigmine was found to have a protective effect on the duration of postoperative mechanical ventilation without increasing the risk of adverse complications.

Authors+Show Affiliations

Houston Methodist Hospital, Houston, TX.Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX.Houston Methodist Hospital, Houston, TX.Houston Methodist Hospital, Houston, TX.Houston Methodist Hospital, Houston, TX. Electronic address: afuentes@houstonmethodist.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31350144

Citation

Xia, Ranran, et al. "Evaluation of Neuromuscular Blockade Reversal On Postoperative Mechanical Ventilation Time in a Cardiovascular Surgery Population." Journal of Cardiothoracic and Vascular Anesthesia, 2019.
Xia R, Kachru N, Tuazon DM, et al. Evaluation of Neuromuscular Blockade Reversal on Postoperative Mechanical Ventilation Time in a Cardiovascular Surgery Population. J Cardiothorac Vasc Anesth. 2019.
Xia, R., Kachru, N., Tuazon, D. M., Bostan, F., & Fuentes, A. (2019). Evaluation of Neuromuscular Blockade Reversal on Postoperative Mechanical Ventilation Time in a Cardiovascular Surgery Population. Journal of Cardiothoracic and Vascular Anesthesia, doi:10.1053/j.jvca.2019.06.025.
Xia R, et al. Evaluation of Neuromuscular Blockade Reversal On Postoperative Mechanical Ventilation Time in a Cardiovascular Surgery Population. J Cardiothorac Vasc Anesth. 2019 Jun 20; PubMed PMID: 31350144.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of Neuromuscular Blockade Reversal on Postoperative Mechanical Ventilation Time in a Cardiovascular Surgery Population. AU - Xia,Ranran, AU - Kachru,Nandita, AU - Tuazon,Divina M, AU - Bostan,Fariedeh, AU - Fuentes,Amaris, Y1 - 2019/06/20/ PY - 2019/03/26/received PY - 2019/06/14/revised PY - 2019/06/17/accepted PY - 2019/7/28/entrez KW - cardiovascular surgery KW - neostigmine KW - nondepolarizing neuromuscular blocking agent KW - postoperative mechanical ventilation JF - Journal of cardiothoracic and vascular anesthesia JO - J. Cardiothorac. Vasc. Anesth. N2 - OBJECTIVE: To report on postoperative outcomes related to the administration of neostigmine for reversal of nondepolarizing neuromuscular blocking agents in cardiovascular surgery patients, with a specific focus on the duration of postoperative mechanical ventilation as the primary endpoint. DESIGN: A retrospective cohort study design was followed to achieve the study objectives. SETTING: This was a single-center, chart review study conducted at a large academic medical center of adult patients post-cardiovascular surgery. PARTICIPANTS: Patients were included if they had received a bolus dose of perioperative nondepolarizing neuromuscular blocking agent and underwent one of the targeted cardiovascular surgeries. INTERVENTIONS: Final analysis comprised of 175 patients, 95 of whom received neostigmine and 80 who did not receive neostigmine. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the duration of postoperative mechanical ventilation. When controlling for all covariates, neostigmine use was associated with a 0.34-hour reduction (∼20.4 min) in duration of mechanical ventilation (parameter estimate: 0.66, 95% confidence interval 0.49-0.89; p = 0.0071). More patients who received neostigmine met the early extubation benchmark of less than 6 hours (55 v 34 patients; p = 0.04). Finally, neostigmine use was not found to be associated with increased risk of respiratory complications or postoperative nausea and/or vomiting. CONCLUSIONS: The use of neostigmine was found to have a protective effect on the duration of postoperative mechanical ventilation without increasing the risk of adverse complications. SN - 1532-8422 UR - https://www.unboundmedicine.com/medline/citation/31350144/Evaluation_of_Neuromuscular_Blockade_Reversal_on_Postoperative_Mechanical_Ventilation_Time_in_a_Cardiovascular_Surgery_Population L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-0770(19)30578-6 DB - PRIME DP - Unbound Medicine ER -