Hypothesis: Patients who receive NMBAs during surgery may be more likely to develop postoperative pneumonia. Among patients who receive NMBAs, patients who do not receive reversal with an acetylcholinesterase inhibitor may also have an increased risk of postoperative pneumonia.
Methods: Over 13,000 cases from a single center (Vanderbilt University) were analyzed using their NSQIP data. Propensity score matching was used to compare cohorts of patients who received NMBAs vs those who didn’t as well as those who received NMBAs with acetylcholinesterase inhibitor reversal vs those who didn’t receive reversal.
Results: Patients were more likely to develop postoperative pneumonia if they received an NMBA (IRR 1.79) and the risk was further increased if their NMBA was not reversed (IRR 2.26).
Strengths: Highly powered study, propensity score matching used, NSQIP data is well-validated
Weaknesses: Limited external generalizability, the study didn’t include TOF data or doses of NMBA given
Key Point: Use of NMBA, and especially lack of NMBA reversal, may increase the risk of postoperative pneumonia.