Evidence map›Paper›PMID 30025517›Full record

SynthesisBMC anesthesiology2018

Postoperative complications with neuromuscular blocking drugs and/or reversal agents in obstructive sleep apnea patients: a systematic review.

Khawaja Rashid Hafeez, Arvind Tuteja, Mandeep Singh, David T Wong, Mahesh Nagappa, Frances Chung, Jean Wong

Registry-linked trialOpen access · goldAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC anesthesiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03737942 (Effect of Type II Diabetes Mellitus With Neuropathy on the Clinical Use of Rocuronium), which is not on this map. Cited by 12 papers.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed
2.9field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03737942 unknown statusnot on this map

Effect of Type II Diabetes Mellitus With Neuropathy on the Clinical Use of Rocuronium: A Pharmacodynamic Modelling Study

TypeobservationalSponsorAssiut UniversityRan2018 to 2019Enrolled60ConditionsNeuromuscular Transmission Disorder, Diabetes Mellitus, Type 2Armsmonitoring of neuromuscular function
3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 41 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 1 country.

Khawaja Rashid HafeezDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 2-405 McLaughlin Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
Arvind TutejaDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 2-405 McLaughlin Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
Mandeep SinghDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 2-405 McLaughlin Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
David T WongDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 2-405 McLaughlin Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
Mahesh NagappaDepartment of Anesthesiology and Perioperative Medicine, University Hospital, St. Joseph's Hospital and Victoria Hospital, London Health Sciences Centre and St. Joseph's Health Care, Western University, London, ON, Canada.
Frances ChungDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 2-405 McLaughlin Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
Jean WongDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 2-405 McLaughlin Wing, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. jean.wong@uhn.ca.ORCID 0000-0002-7213-4898
University Health Network · CAToronto Western Hospital · CAWestern University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNeuromuscular 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.

methodsA 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.

resultsOut 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.

conclusionsOSA 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.

Indexed as

HumansNeostigmineNeuromuscular Blocking AgentsParasympathomimeticsPostoperative ComplicationsSleep Apnea, ObstructiveSugammadexNeostigmineNeuromuscular Blocking AgentsParasympathomimeticsSugammadexNeuromuscular blocking agentsObstructive sleep apneaPostoperative pulmonary complicationsResidual neuromuscular blockadeReversal of neuromuscular blocking agents

Identifiers

PMID30025517
PMCPMC6053808
OpenAlexW2884785146

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.