Pulmonary function decline in immediate postoperative period is not necessarily related to residual neuromuscular block: An observational study

Eur J Anaesthesiol. 2020 Nov;37(11):1008-1013. doi: 10.1097/EJA.0000000000001221.


Background: Previous studies have reported an association between the use of neuromuscular blocking (NMB) agents and postoperative pulmonary complications. Postoperative pulmonary function is a key indicator for postoperative pulmonary complications. Several sites can be used to assess depth and recovery from NMB.

Objectives: To investigate postoperative pulmonary function change in relation to train-of-four measurements at the adductor pollicis and corrugator supercilii muscles, and anaesthesia-related variables in orthopaedic patients undergoing hip or knee arthroplasty.

Design: Observational study.

Setting: University hospital.

Patients: Orthopaedic patients undergoing hip or knee arthroplasty.

Main outcome measures: Postoperative pulmonary function tests in the postanaesthesia care unit.

Methods: Patients scheduled for elective hip or knee arthroplasty received simultaneous corrugator supercilii and adductor pollicis measurements during anaesthesia conducted according to clinical standards. Forced expiratory volume in 1 s and forced vital capacity (FVC) were measured at the time of inclusion and postoperatively on the postanaesthesia care unit. Linear regression analysis was performed for association between risk factors and pulmonary function change.

Results: A total of 35 patients were included. After exclusions, 20 patients remained for final analysis. Corrugator supercilii showed earlier NMB recovery than adductor pollicis. FVC decreased significantly after surgery from 2.9 ± 1.0 to 2.3 ± 1.0 (P < 0.01) and forced expiratory volume in 1 s decreased from 2.3 ± 0.9 to 1.6 ± 0.8 l (P < 0.01). Patient age was the only factor significantly related to FVC decrease after surgery (P = 0.019) with a cut-off value of 65 years.

Conclusion: Both corrugator supercilii and adductor pollicis failed to indicate recovery of pulmonary function after NMB. Age seems to be a risk factor for postoperative decline in pulmonary function.

Trial registration: German Clinical Trials registry, DRKS-ID: DRKS00014305.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Delayed Emergence from Anesthesia*
  • Electric Stimulation
  • Facial Muscles
  • Humans
  • Neuromuscular Blockade* / adverse effects
  • Postoperative Period

Associated data

  • DRKS/DRKS00014305