title: Incidence of postoperative residual neuromuscular blockade after general anesthesia: a prospective, multicenter, anesthetist-blind, observational study.
abstract: OBJECTIVE
  Evidences demonstrate that postoperative residual neuromuscular blockade (rNMB) is a primary and frequent anesthetic risk factor for postoperative complications. This study was designed to mitigate the paucity of data regarding the occurrence and degree of rNMB in a real-life setting.
  
  
  METHODS
  This prospective, multicenter, anesthetist-blind, observational study enrolled 1571 Chinese adults undergoing elective open or laparoscopic abdominal surgery lasting ≤4 hours from 32 hospitals across China. The patients received anesthesia in accordance with routine practice at the study site. Neuromuscular blockade (NMB) was monitored using acceleromyography, with rNMB defined as a train-of-four (TOF) ratio <0.9.
  
  
  RESULTS
  The patients' mean age was 46 years and 71% were female. The procedures included laparoscopic (67%), open abdominal (31%), and laparoscopic to open abdominal (2%). NMB was reversed with neostigmine in 78% of patients. The overall incidence of rNMB at extubation was 57.8%, and the proportions of participant with TOF ratios <0.6, 0.6-0.7, 0.7-0.8, 0.8-0.9 were 22.9%, 6.9%, 11.1% and 16.9%, respectively, immediately prior to endotracheal extubation. Age <45 years (OR = 0.630, 95% CI = 0.496-0.801, p = 0.002), use of one neuromuscular blocking agent (NMBA) (OR = 0.387, 95% CI = 0.243-0.618, p < 0.0001), time from neostigmine administration to endotracheal extubation ≥10 min (OR = 0.513, 95% CI = 0.400-0.658, p < 0.0001) and time from last NMBA administration to endotracheal extubation ≥60 min (OR = 0.902, 95% CI = 0.801-0.989, p = 0411) were correlated with non-rNMB at the time of extubation.
  
  
  CONCLUSIONS
  This observational study demonstrated that the overall incidence of rNMB at the time of endotracheal extubation was high in Chinese patients undergoing abdominal procedures, which necessitates appropriate management in current real-life practice.
  
  
  BACKGROUND
  NCT01871064.
authors.affiliation: a a Department of Anesthesiology , Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.
authors.forename: Buwei
authors.initials: B
authors.lastname: Yu
authors.affiliation: b b The First Affiliated hospital of Guangzhou Medical University , Guangzhou , China.
authors.forename: Baoyi
authors.initials: B
authors.lastname: Ouyang
authors.affiliation: c c Zhongshan Hospital of Fudan University , Shanghai , China.
authors.forename: Shengjin
authors.initials: S
authors.lastname: Ge
authors.affiliation: a a Department of Anesthesiology , Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Luo
authors.affiliation: d d The Second Affiliated Hospital of Wenzhou Medical College , Wenzhou , China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: e e Peking University First Hospital , Beijing , China.
authors.forename: Dongmei
authors.initials: D
authors.lastname: Ni
authors.affiliation: f f Zhejiang Provincial People's Hospital , Hangzhou , China.
authors.forename: Shuangfei
authors.initials: S
authors.lastname: Hu
authors.affiliation: g g Tongji Hospital, Tongji Medical College of Huazhong University of Science & Technology , Wuhan , China.
authors.forename: Hui
authors.initials: H
authors.lastname: Xu
authors.affiliation: h h West China Hospital, West China School of Medicine, Sichuan University , Chengdu , China.
authors.forename: Jin
authors.initials: J
authors.lastname: Liu
authors.affiliation: i i The First Affiliated Hospital of Chongqing Medical University , Chongqing , China.
authors.forename: Su
authors.initials: S
authors.lastname: Min
authors.affiliation: j j China-Japan Union Hospital, Jilin University , Changchun , China.
authors.forename: Longyun
authors.initials: L
authors.lastname: Li
authors.affiliation: k k Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School , Nanjing , China.
authors.forename: Zhengliang
authors.initials: Z
authors.lastname: Ma
authors.affiliation: l l Zhejiang Cancer Hospital , Hangzhou , China.
authors.forename: Kangjie
authors.initials: K
authors.lastname: Xie
authors.affiliation: m m Fudan University Shanghai Cancer Center , Shanghai , China.
authors.forename: Changhong
authors.initials: C
authors.lastname: Miao
authors.affiliation: e e Peking University First Hospital , Beijing , China.
authors.forename: Xinmin
authors.initials: X
authors.lastname: Wu
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D055191:Delayed Emergence from Anesthesia; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000494:pharmacology; D019148:Neuromuscular Blockade; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies
chemical_list: D009388:Neostigmine
keywords: General anesthesia; Observational study; Residual neuromuscular blockade; Train-of-four monitoring