Adverse Respiratory Events in a Post-Anesthesia Care Unit

Abstract

IntroductionAdverse respiratory events (AREs) are leading causes of postoperative morbidity and mortality. This study investigated the incidence and determinants of postoperative ARE. MethodsThis observational prospective study was conducted in a post-anesthesia care unit (PACU). A total of 340 adult subjects were admitted consecutively, and AREs were measured after elective surgery. Population demographics, perioperative parameters, ARE occurrence, and length of stay in the postoperative PACU and in hospital were recorded. Data were analyzed descriptively using the Mann–Whitney U-test and the Chi-square or Fisher's exact test. Multivariate analyses were carried out using logistic binary regression, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. ResultsPostoperative AREs occurred in 67 subjects (19.7%). AREs were more frequent after high-risk procedures (42% vs 24%; P=.003), in patients undergoing major surgery (37% vs 25%; P=.041), those receiving general anesthesia (85% vs 67%; P=.004), and in patients administered intraoperative muscle relaxants (79% vs 55%; P<.001) and neostigmine (69% vs 49%; P=.002). Hypoactive emergence (13% vs 5%; P=.015) and residual neuromuscular blockade (46% vs 11%; P<.001) were more frequent in subjects with postoperative ARE. On multivariate analyses, residual neuromuscular blockade was an independent risk factor for ARE in the PACU (OR 6.4; CI 3.0–13.4; P<.001). ConclusionsARE is an important and common postoperative complication. Residual neuromuscular blockade was an independent risk factor for ARE in the PACU.