PDF(Pubmed)
Abstract：
Neuromuscular blocking drugs (NMBD) are administered intra-operatively to facilitate intubation and to achieve muscle relaxation for surgical procedures. Incomplete reversal of NMBD can lead to adverse events in the postoperative period. Patients with obstructive sleep apnea (OSA) may be at higher risk of complications related to the use of NMBD. The objectives of this systematic review were to determine whether: 1) OSA patients are at higher risk of postoperative complications from the use of NMBD than non-OSA patients, and 2) the choice of NMBD reversal agent affects the risk of postoperative complications in OSA patients.
A literature search of multiple databases was conducted up to April 2017. The inclusion criteria were: (1) adult surgical patients (≥18 years old) with OSA diagnosed by polysomnography, or history, or suspected by screening questionnaire; (2) patients who were given NMBD and/or NMBD reversal agents intraoperatively; (3) reports on postoperative adverse events, particularly respiratory events were available; (4) published studies were in English; and (5) RCTs or observational cohort studies. The quality of evidence was determined by the Oxford Center for Evidence Based Medicine levels of evidence.
Out of 4123 studies, five studies (2 RCTs and 3 observational studies) including 1126 patients were deemed eligible. These studies were heterogeneous precluding a meta-analysis of the results. Two of three studies (1 RCT, 2 observational studies) reported that OSA patients given NMBD may be at higher risk of developing postoperative pulmonary complications (PPCs) like hypoxemia, residual neuromuscular blockade or respiratory failure compared to non-OSA patients. Two studies (1 RCT, 1 observational study) reported that OSA patients who were reversed with sugammadex vs. neostigmine had less PPCs and chest radiographic changes, but the quality of the included studies was Oxford level of evidence: low to moderate.
OSA patients who receive intraoperative NMBD may be at higher risk for postoperative hypoxemia, respiratory failure and residual neuromuscular blockade compared to non-OSA patients. There is some, albeit very limited evidence that NMBD reversal with sugammadex may be associated with less PPCs than neostigmine in patients with OSA. More high-quality studies are needed.
A literature search of multiple databases was conducted up to April 2017. The inclusion criteria were: (1) adult surgical patients (≥18 years old) with OSA diagnosed by polysomnography, or history, or suspected by screening questionnaire; (2) patients who were given NMBD and/or NMBD reversal agents intraoperatively; (3) reports on postoperative adverse events, particularly respiratory events were available; (4) published studies were in English; and (5) RCTs or observational cohort studies. The quality of evidence was determined by the Oxford Center for Evidence Based Medicine levels of evidence.
Out of 4123 studies, five studies (2 RCTs and 3 observational studies) including 1126 patients were deemed eligible. These studies were heterogeneous precluding a meta-analysis of the results. Two of three studies (1 RCT, 2 observational studies) reported that OSA patients given NMBD may be at higher risk of developing postoperative pulmonary complications (PPCs) like hypoxemia, residual neuromuscular blockade or respiratory failure compared to non-OSA patients. Two studies (1 RCT, 1 observational study) reported that OSA patients who were reversed with sugammadex vs. neostigmine had less PPCs and chest radiographic changes, but the quality of the included studies was Oxford level of evidence: low to moderate.
OSA patients who receive intraoperative NMBD may be at higher risk for postoperative hypoxemia, respiratory failure and residual neuromuscular blockade compared to non-OSA patients. There is some, albeit very limited evidence that NMBD reversal with sugammadex may be associated with less PPCs than neostigmine in patients with OSA. More high-quality studies are needed.
摘要：
神经肌肉阻断药物（NMBD）在术中给药，以促进插管并实现外科手术的肌肉松弛。NMBD的不完全逆转可导致术后期间的不良事件。阻塞性睡眠呼吸暂停（OSA）患者可能与使用NMBD相关的并发症风险更高。本系统评价的目的是确定是否：1）OSA患者使用NMBD比非OSA患者发生术后并发症的风险更高，2)NMBD逆转剂的选择影响OSA患者术后并发症的风险。
截至2017年4月，对多个数据库进行了文献检索。纳入标准为：（1）经多导睡眠图诊断为OSA的成人手术患者（≥18岁），或历史，或通过筛查问卷怀疑；（2）术中给予NMBD和/或NMBD逆转剂的患者；（3）术后不良事件报告，可获得特别是呼吸事件;(4)已发表的研究为英文;(5)随机对照试验或观察性队列研究.证据质量由牛津循证医学中心的证据水平决定。
在4123项研究中，纳入1126例患者的5项研究(2项RCT和3项观察性研究)被认为符合条件.这些研究是异质性的，排除了对结果的荟萃分析。三项研究中的两项(1项RCT，2观察性研究）报道，接受NMBD的OSA患者可能发生术后肺部并发症（PPCs）如低氧血症的风险更高，与非OSA患者相比，残余神经肌肉阻滞或呼吸衰竭。两项研究（1项RCT，1项观察性研究）报告，使用sugammadex逆转的OSA患者与新斯的明的PPC和胸部影像学改变较少，但纳入研究的质量是牛津水平的证据:低到中等.
术中接受NMBD的OSA患者术后低氧血症的风险较高，与非OSA患者相比，呼吸衰竭和残余神经肌肉阻滞。有一些,尽管非常有限的证据表明，在OSA患者中，Sugammadex逆转NMBD的PPC可能比新斯的明少。需要更多高质量的研究。
截至2017年4月，对多个数据库进行了文献检索。纳入标准为：（1）经多导睡眠图诊断为OSA的成人手术患者（≥18岁），或历史，或通过筛查问卷怀疑；（2）术中给予NMBD和/或NMBD逆转剂的患者；（3）术后不良事件报告，可获得特别是呼吸事件;(4)已发表的研究为英文;(5)随机对照试验或观察性队列研究.证据质量由牛津循证医学中心的证据水平决定。
在4123项研究中，纳入1126例患者的5项研究(2项RCT和3项观察性研究)被认为符合条件.这些研究是异质性的，排除了对结果的荟萃分析。三项研究中的两项(1项RCT，2观察性研究）报道，接受NMBD的OSA患者可能发生术后肺部并发症（PPCs）如低氧血症的风险更高，与非OSA患者相比，残余神经肌肉阻滞或呼吸衰竭。两项研究（1项RCT，1项观察性研究）报告，使用sugammadex逆转的OSA患者与新斯的明的PPC和胸部影像学改变较少，但纳入研究的质量是牛津水平的证据:低到中等.
术中接受NMBD的OSA患者术后低氧血症的风险较高，与非OSA患者相比，呼吸衰竭和残余神经肌肉阻滞。有一些,尽管非常有限的证据表明，在OSA患者中，Sugammadex逆转NMBD的PPC可能比新斯的明少。需要更多高质量的研究。
