Predictive Study of Pharmacological Reversal for Residual Neuromuscular Blockade, Early and Late Postoperative Pulmonary Complications: A Prospective, Observational, Cohort Study

Background The primary objective was to assess the incidence of residual neuromuscular blockade and postoperative pulmonary complications according to spontaneous or pharmacological neuromuscular reversal, comparing neostigmine and sugammadex. The secondary objective was to present a prognostic model to predict the probability of having residual neuromuscular blockade depending on patient's comorbidities and intraoperative neuromuscular blocking agents management. Methods Single-center, prospective, observational, cohort study including patients undergoing surgical procedures with general anaesthesia divided into four groups: cisatracurium, cisatracurium with neostigmine antagonism, rocuronium, and rocuronium with sugammadex antagonism. A binomial generalized linear model was used to predict the residual neuromuscular blockade analyzing patients demographic data, comorbidities, intraoperative neuromuscular monitoring and pharmacological reversal for each patient group. Results A total of 714 patients were analyzed. According to our model, none of the studied comorbidities were a predisposing factor for an increase in residual neuromuscular blockade. However, the use of rocuronium, pharmacological reversal with sugammadex, and, particularly, neuromuscular monitoring during surgery markedly decreased the probability. When using rocuronium, avoidance of neuromuscular monitoring and pharmacological reversal led to an incidence of residual neuromuscular blockade of 41.27%; conversely, the use of neuromuscular monitoring and pharmacological reversal with sugammadex decreased the probability to 2.17%. Conclusions In our study, intraoperative neuromuscular monitoring and pharmacological reversal with sugammadex, unlike neostigmine, were the factors that most effectively reduced the risk of residual neuromuscular blockade as well as early postoperative pulmonary complications in PACU (upper airway obstruction and desaturation) and late postoperative pulmonary complications (pneumonia or atelectasis) within 30 days.