Breaking News
April 25, 2019 - Cardiometabolic Risk Better ID’d in Children Reclassified to Higher BP
April 25, 2019 - How the obesity epidemic is taking a toll on our bones and joints
April 25, 2019 - E-cigarettes contaminated with dangerous microbial toxins
April 25, 2019 - Researchers document specific characteristics of storefront tobacco advertisements
April 25, 2019 - Oncotype DX-guided treatment could reduce cost for breast cancer care, study suggests
April 25, 2019 - New review highlights how lifestyle affects our genes
April 25, 2019 - Study provides evidence that blood tests can detect Alzheimer’s risk
April 25, 2019 - Physicians turning to antibiotic alternatives for long-term acne treatment
April 25, 2019 - Preschool Is Prime Time to Teach Healthy Lifestyle Habits
April 25, 2019 - Study finds insidious and persistent discrimination among physician mothers
April 25, 2019 - Newly identified skin-gut communication helps illuminate link between food allergy and eczema
April 25, 2019 - Thiazide use linked with reduced risk of low energy fractures in people with Alzheimer’s
April 25, 2019 - Some women are biologically more resilient than others to PTSD
April 25, 2019 - The Current issue of “The view from here” is concerned with Partnerships and Alliances
April 25, 2019 - Imaging method reveals long-lived patterns in cells of the eye
April 25, 2019 - Podcast: KHN’s ‘What The Health?’ The Abortion Wars Rage On
April 25, 2019 - Prolonged exposure therapy is more effective in treating veterans with PTSD, alcohol use disorder
April 24, 2019 - Our artificial cornea breakthrough could lead to self-assembling organs
April 24, 2019 - A Stanford black, female, gay surgery resident speaks out
April 24, 2019 - Donna Lynne on Extreme Sports, Lessons From the '60s, and Taking CUIMC to the Next Level
April 24, 2019 - Pain Clinics’ Doctors Needlessly Tested Hundreds Of Urine Samples, Court Records Show
April 24, 2019 - Researchers uncover potential clue to halt destruction of nerve cells in people with ALS
April 24, 2019 - Study uncovers reasons for poor mental health in bisexual people
April 24, 2019 - Screenings, interventions, and referrals can help adolescents overcome substance abuse
April 24, 2019 - Febrile seizures following vaccination are self-resolving and not dangerous
April 24, 2019 - Flow-UV inline UV-Visible spectrometer monitors dispersion in real time
April 24, 2019 - Rates of Marijuana Use in Cancer Patients on the Rise in U.S.
April 24, 2019 - Versatile drug may protect baby from hazards of intraamniotic infections
April 24, 2019 - Financial transparency may diminish trust in doctors, new study finds
April 24, 2019 - Calling all Riders: Velocity Extends Free Registration 
April 24, 2019 - The Homeless Are Dying In Record Numbers On The Streets Of L.A.
April 24, 2019 - Researchers use brain scans to provide better understanding of unconscious bias
April 24, 2019 - Blocking BRAF ubiquitination may be an effective treatment approach in melanoma
April 24, 2019 - Simple mobility test helps predict hospital readmission in elderly heart attack patients
April 24, 2019 - Novel fluorescence imaging system helps surgeons remove small ovarian tumors
April 24, 2019 - Uncovering the Structure of HIV Integrase to Inform Drug Discovery
April 24, 2019 - Medical Marijuana Use Rising Among Cancer Patients
April 24, 2019 - Artificial intelligence approach optimizes embryo selection for IVF
April 24, 2019 - Doctor or detective? Sleuthing mysteries in medical school
April 24, 2019 - CUIMC Community Gives Blood During Spring 2019 Columbia University Blood Drive
April 24, 2019 - Americans Overwhelmingly Want Federal Protections Against Surprise Medical Bills
April 24, 2019 - Making Laboratories More Efficient with the Most Modern LIMS on the Market
April 24, 2019 - Treating cancer patients with personalized, combination therapies improves outcomes
April 24, 2019 - Researchers engineer new molecules to help stop lung cancer
April 24, 2019 - Acupuncture can be a wonderful tool for preventing number of diseases
April 24, 2019 - Daily life disability before hip replacement may predict poor post-operative outcomes
April 24, 2019 - Study finds involuntary staying in housing estates to be a potential health risk
April 24, 2019 - Older kidney disease patients starting dialysis die at higher rates than previously thought
April 24, 2019 - Time-restricted eating shows promise for controlling blood glucose levels
April 24, 2019 - Ambiguous genitalia in newborns may be more common than previously thought
April 24, 2019 - Research provides important insight on the brain-body connection
April 24, 2019 - In 10 Years, Half Of Middle-Income Elders Won’t Be Able To Afford Housing, Medical Care
April 24, 2019 - Researchers study how E. coli clones have become major cause of drug-resistant infections
April 24, 2019 - Bacterial and fungal toxins found in popular electronic cigarettes
April 24, 2019 - Factors affecting absorption of ‘sunshine vitamin’ during spring/summer months
April 24, 2019 - Texting helps improve medication adherence, health outcomes for patients with schizophrenia
April 24, 2019 - Cochrane Review looks at different ways to use nicotine replacement therapies
April 24, 2019 - New review on relationship between COPD and Type 2 diabetes
April 24, 2019 - Brain areas linked to memory and emotion aid odor navigation in humans
April 24, 2019 - Brain stimulation reverses age-related memory loss
April 24, 2019 - Amid Opioid Prescriber Crackdown, Health Officials Reach Out To Pain Patients
April 24, 2019 - $4 million NIH award will help establish UCI Skin Biology Resource-based Center
April 24, 2019 - Cancer drugs reprogram genes in breast tumors to prevent endocrine resistance, finds study
April 24, 2019 - Combination-imaging technique provides new window into macaque brain connections
April 24, 2019 - Researchers identify new allergen responsible for allergy to durum wheat
April 24, 2019 - Researchers define role of rare, influential cells in the bone marrow
April 24, 2019 - DNA rearrangement may predict poor outcomes in multiple myeloma
April 24, 2019 - FDA Approves Skyrizi (risankizumab-rzaa) for Moderate to Severe Plaque Psoriasis
April 24, 2019 - Combination therapy might be beneficial in schizophrenia
April 24, 2019 - Blood test can help match cancer patients to early phase clinical trials
April 24, 2019 - Women tend to underreport snoring and underestimate its loudness
April 24, 2019 - Comprehensive molecular test introduced for diagnosis of malaria caused by P. vivax parasites
April 24, 2019 - New range prediction approach increases accuracy, safety and tolerability of proton therapy
April 24, 2019 - Need for Sedation Up for Regular Cannabis Users
April 24, 2019 - Lack of access to antibiotics is a major global health challenge
April 24, 2019 - New study provides better understanding on safety of deworming programs
April 24, 2019 - EEG used to detect impact of maternal stress on neurodevelopment in 2-month-old infants
April 24, 2019 - FDA Approves First Generic Naloxone Nasal Spray Against Opioid Overdose
April 24, 2019 - A new way of finding compounds that prevent aging
April 24, 2019 - Mechanical training makes synthetic hydrogels perform more like muscle
Muscle relaxants increase risk of respiratory complications

Muscle relaxants increase risk of respiratory complications

image_pdfDownload PDFimage_print
Credit: CC0 Public Domain

Muscle relaxants are a necessary part of anesthesia during certain major operations. However, studies have hinted at respiratory risks connected with these drugs. POPULAR, a major prospective observational European study has confirmed the association between the use of muscle relaxants and respiratory complications, and assessed the chances of the current avoidance strategies.

Anesthetics make patients unconscious during an operation and prevent them from feeling pain. Muscles, however, are not paralyzed by these drugs and may still move. “To prevent this, we also use muscle relaxants or, more precisely, neuromuscular blocking agents,” says Professor Manfred Blobner, an anesthesiologist at TUM’s Clinic for Anesthesiology and Intensive Care.

“These drugs are particularly important when operating on a patient’s chest or abdomen. They are also used to protect the vocal cords from injury when a tube is placed in the airway to allow artificial ventilation,” says Blobner who is the chair of the POPULAR steering committee, a multinational group of researchers. The prospective observational POPULAR study collected data from 22,803 patients of 211 hospitals in 28 European countries.

The first results from this study are now being published in The Lancet Respiratory Medicine. They confirm what earlier studies based on pre-existing data had hinted at: The use of neuromuscular blockers during general anesthesia is associated with a significantly increased risk of several respiratory complications after surgery.

The most common complications involving the respiratory system were a reduced capacity of the lungs to absorb oxygen transiently (5.2 percent), and infections of the lung and respiratory tract (2.5 percent). Roughly three quarters of all patients (17150 people) were treated with neuromuscular blocking agents. They were shown to have a significantly higher risk (+4.4 percent) of developing any type of respiratory complication.

Neither monitoring nor drugs lower the risk

The study did not look into how the use of muscle relaxants might cause the negative effects. Earlier studies have shown that even small amounts of muscle relaxants remaining in the bodies of patients could be responsible for some of the complications. The data from POPULAR, however, show that established techniques used to avoid residual neuromuscular block do not lower the patients’ risk of pulmonary complications.

The respiratory outcome was not changed by drugs reversing the effects of the muscle relaxants, or monitoring the neuromuscular function during anesthesia to ensure complete recovery of muscle function. The researchers point out that this does not mean that these measures are unable to reduce residual paralysis, but they must be used correctly. There may be flaws in the way these measures are implemented as well as other unknown causes for the complications.

“It’s important to note that neuromuscular blocking agents have made surgery considerably safer and more effective since their introduction several decades ago,” says Professor Blobner. “We have constantly refined both the drugs and the techniques used. Many operations would not be possible without them. Still, the results from POPULAR raise important questions.”

Blobner and co-authors are planning to implement more targeted studies to identify the underlying mechanisms behind their findings. “Based on our results, we believe that patients undergoing minor surgical procedures that do not necessarily require neuromuscular blocking drugs might benefit from avoiding them. Using devices like laryngeal masks for anesthesia instead of tracheal tubes that go past the vocal cords could prove helpful as well,” says Blobner.


Explore further:
Muscle relaxants linked with increased risk of breathing problems after surgery

More information:
Kirmeier E, Eriksson LI, Lewald H, Jonsson Fagerlund M, Hoeft A, Hollmann M, Meistelman C, Hunter JM, Ulm K, Blobner M. “Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study”. Published online September 14, 2018. DOI: 10.1016/S2213-2600(18)30294-7

Journal reference:
Lancet Respiratory Medicine

Provided by:
Technical University Munich

About author

Related Articles