Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 22;10(15):3228.
doi: 10.3390/jcm10153228.

Effect of Deep versus Moderate Neuromuscular Blockade on Quantitatively Assessed Postoperative Atelectasis Using Computed Tomography in Thoracic Surgery; a Randomized Double-Blind Controlled Trial

Bong-Jae Lee  1 , Han Na Lee  2 , Jun-Young Chung  1 , Daehyun Kim  3 , Jung Im Kim  2 , Hyungseok Seo  1
Affiliations

Effect of Deep versus Moderate Neuromuscular Blockade on Quantitatively Assessed Postoperative Atelectasis Using Computed Tomography in Thoracic Surgery; a Randomized Double-Blind Controlled Trial

Bong-Jae Lee et al. J Clin Med. .

Abstract

Background: postoperative atelectasis is a significant clinical problem during thoracic surgery with one-lung ventilation. Intraoperative deep neuromuscular blockade can improve surgical conditions, but an increased risk of residual paralysis may aggravate postoperative atelectasis. Every patient was verified to have full reversal before extubation. We compared the effect of deep versus moderate neuromuscular blockade on postoperative atelectasis quantitatively using chest computed tomography.

Methods: patients undergoing thoracic surgery were randomly allocated to two groups: moderate neuromuscular blockade during surgery (group M) and deep neuromuscular blockade during surgery (group D). The primary outcome was the proportion and the volume of postoperative atelectasis measured by chest computed tomography on postoperative day 2. The mean values of the repeatedly measured intraoperative dynamic lung compliance during surgery were also compared.

Result: the proportion of postoperative atelectasis did not differ between the groups (1.32 [0.47-3.20]% in group M and 1.41 [0.24-3.07]% in group D, p = 0.690). The actual atelectasis volume was 38.2 (12.8-61.4) mL in group M and 31.9 (7.84-75.0) mL in group D (p = 0.954). Some factors described in the lung protective ventilation were not taken into account and might explain the atelectasis in both groups. The mean lung compliance during one-lung ventilation was higher in group D (26.6% in group D vs. 24.1% in group M, p = 0.026).

Conclusions: intraoperative deep neuromuscular blockade did not affect postoperative atelectasis when compared with moderate neuromuscular blockade if full reversal was verified.

Keywords: atelectasis; deep block; neuromuscular blockade; postoperative pulmonary complications; sugammadax.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Quantitatively measured volume of an atelectatic lung using threshold methods in chest computed tomography. For the calculation of atelectatic lung volume, the area with predefined Hounsfield unit (HU) threshold of −100 to 100 HU was selected in the chest computed tomography images (yellow circle on the left) and reconstructed (yellow circle on the right).
Figure 2
Figure 2
The CONSORT flowchart.
Figure 3
Figure 3
Comparison of mean dynamic lung compliance during one-lung ventilation between group M (blue circle) and group D (red box).
Figure 4
Figure 4
Comparison of the proportion of postoperative atelectasis between group M (blue line) and group D (red line).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Fernandez-Bustamante A., Frendl G., Sprung J., Kor D.J., Subramaniam B., Martinez Ruiz R., Lee J.W., Henderson W.G., Moss A., Mehdiratta N., et al. Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators. JAMA Surg. 2017;152:157–166. doi: 10.1001/jamasurg.2016.4065. - DOI - PMC - PubMed
    1. Blank R.S., Colquhoun D.A., Durieux M.E., Kozower B.D., McMurry T.L., Bender S.P., Naik B.I. Management of One-lung Ventilation: Impact of Tidal Volume on Complications after Thoracic Surgery. Anesthesiology. 2016;124:1286–1295. doi: 10.1097/ALN.0000000000001100. - DOI - PubMed
    1. Miskovic A., Lumb A.B. Postoperative pulmonary complications. Br. J. Anaesth. 2017;118:317–334. doi: 10.1093/bja/aex002. - DOI - PubMed
    1. Young C.C., Harris E.M., Vacchiano C., Bodnar S., Bukowy B., Elliott R.R.D., Migliarese J., Ragains C., Trethewey B., Woodward A., et al. Lung-protective ventilation for the surgical patient: International expert panel-based consensus recommendations. Br. J. Anaesth. 2019;123:898–913. doi: 10.1016/j.bja.2019.08.017. - DOI - PubMed
    1. Cammu G. Residual Neuromuscular Blockade and Postoperative Pulmonary Complications: What Does the Recent Evidence Demonstrate? Curr. Anesthesiol. Rep. 2020;10:131–136. doi: 10.1007/s40140-020-00388-4. - DOI - PMC - PubMed

LinkOut - more resources