Rocuronium is associated with an increased risk of reintubation in patients with soft tissue infections.
OBJECTIVE
To determine risk factors associated with reintubations in adult patients with soft tissue infections.


METHODS
A retrospective case-control design.


METHODS
Operating room and postoperative recovery area.


METHODS
There were 39 patients who presented for surgical intervention of their soft tissue infection and 222 controls having general surgery who were matched for age, sex, and body mass index. All patients were older than the age of 18 years and mostly American Society of Anesthesiologists physical status of III to IV and presented to our level 1 trauma center.


METHODS
Reintubation within 2 hours after planned extubation.


METHODS
The following data were collected: reintubation rates, train of four ratio, reversal agents, age, sex, creatinine, smoking history, transfusion requirements, Sequential Organ Failure Assessment score, hemoglobin, and lactate.


RESULTS
The use of rocuronium was independently associated with increased odds of reintubation. Patients with a higher train of four ratio were more likely to be reintubated and less likely to be reversed as compared to those with a lower train of four ratio.


CONCLUSIONS
Soft tissue patients who have received rocuronium are at increased risk for reintubation, particularly those with renal failure. In addition, this article supports the use of neuromuscular blockade reversals, even in patients with a strong train of four ratio.
Division of Trauma Anesthesiology, Department of Anesthesiology, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201. Electronic address: kgreco@anes.umm.edu.
Karla M
KM
Greco
Division of Trauma Anesthesiology, Department of Anesthesiology, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201. Electronic address: bconti@anes.umm.edu.
Bianca M
BM
Conti
Division of Trauma Anesthesiology, Department of Anesthesiology, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201. Electronic address: cbucci@anes.umm.edu.
Cynthia J
CJ
Bucci
Division of Trauma Anesthesiology, Department of Anesthesiology, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201; Division of Critical Care Medicine University of Maryland School of Medicine, Baltimore, MD 21201. Electronic address: sgalvagno@anes.umm.edu.
Samuel M
SM
Galvagno
D000328:Adult; D000368:Aged; D060666:Airway Extubation / Q000706:statistics & numerical data*; D000732:Androstanols / Q000008:administration & dosage / Q000009:adverse effects*; D000762:Anesthesia Recovery Period; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000379:methods*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D000077123:Rocuronium; D018461:Soft Tissue Infections / Q000150:complications / Q000601:surgery*
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium
Extubation failure; Neuromuscular blockade drugs; Reintubation; Rocuronium; Soft tissue infection; Structural equation modeling