RESIDUAL NEUROMUSCULAR BLOCK IS A RISK FACTOR FOR POSTOPERATIVE PULMONARY COMPLICATIONS - A PROSPECTIVE, RANDOMIZED, AND BLINDED STUDY OF POSTOPERATIVE PULMONARY COMPLICATIONS AFTER ATRACURIUM, VECURONIUM AND PANCURONIUM

Background: After anaesthesia involving pancuronium a high incidence o f both residual neuromuscular block and postoperative pulmonary compli cations (POPC) has been reported. The aim of this study was to compare the incidence of POPC following the use of pancuronium, atracurium, a nd vecuronium, and to examine the effect of residual neuromuscular blo ck on the incidence of POPC. Methods: A total of 691 adult patients un dergoing abdominal, gynaecological, or orthopaedic surgery under gener al anaesthesia were randomised to receive either pancuronium, atracuri um, or vecuronium. Perioperatively, the response to train-of-four (TOF ) nerve stimulation was evaluated manually. Postoperatively the TOF ra tios were measured mechanomyographically, and through a 6-day follow-u p the patients were examined for pulmonary complications. Results: The incidence of residual block, defined as a TOF ratio <0.7, was signifi cantly higher in the pancuronium group (59/226: 26%) than in the atrac urium/vecuronium groups (24/450: 5.3%). In the pancuronium group, sign ificantly more patients with residual block developed POPC (10/59: 16. 9%) as compared to patients without residual block (8/167: 4.8%). Ln t he atracurium/vecuronium groups, the incidence of POPC was not signifi cantly different in patients with (1/24: 4.2%) or without (23/426: 5.4 %) residual block. Multiple regression analysis indicated that abdomin al surgery, age, long-lasting surgery, and a TOF ratio<0.7 following t he use of pancuronium were potential risk factors for the development of POPC. Conclusion: Postoperative residual block caused by pancuroniu m is a significant risk factor for development of POPC. (C) Acta Anaes thesiologica Scandinavica 41 (1997).