Eventos adversos en el perioperatorio relacionados con el uso de bloqueantes neuromusculares comparado con no utilizarlos durante la anestesia general en adultos : revisión sistemática de la literatura

Abstract

Introduction: Neuromuscular Blockers Agents (NMBA) are routinely used in anaesthesia, although they don´t have anaesthetic properties and adverse events and mortality have been reported. Muscular relaxation is more a result of quality of anaesthesia that a muscular paralysis. Like this, abdominal surgeries are realized under anaesthesia without NMBA. Efforts made to avoid Postoperative Residual Curarization and intraoperative awareness have not diminished their incidence, and risk of use NMBA is not established. Judicious use of NMBA in specific situations may decrease adverse effects and cost of anaesthesia. Objective: Make a comparison of frequency of adverse events on perioperative period of adult patients, who suffer surgical procedures under general anaesthesia, in whose received NMBA with respect those received other techniques without NMBA. Methods: Systematic Review of literature. Eligibility criteria: Clinical trial if were published, observational studies in adults with surgery that reporting adverse events and mortality during perioperative period with use or without NMBAs. Studies on paediatric or obese patient, trauma, obstetric and cardiac surgery were excluded. Search and select Methods: Last fifteen years in PubMed, EMBASE, LILACS, Cochrane, and grey literature, without exclusion languages, seeking with Decs, Mesh, emtree and synonymous. Search strategy was: "Anaesthesia" (P) + "Neuromuscular Blocking Agents" (I) + “Adverse Effects” (O), including synonymous. We will use PRISMA (Preferred Items for Systematic Reviews and Metanalysis) flow chart and checklist. The protocol was registered on PROSPERO with the number CRD42019128550 and only was modified search strategy before beginning. Collect and analysis: Mendeley will be selected as reference manager. Independently, three reviewers seemed, selected and evaluated quality of articles. In disagreement case, a fourth reviewer decided. PRISMA checklist will be used to design of review, Review Manager 5 to analyse cuantitative data. Frequency of adverse events was measured, incidence of residual neuromuscular blockade, relative risk and others according information available and homogeneity of studies. Checklist CONSORT, STROBE, New Castle-Ottawa and risk of bias tool of Cochrane and GRADE System for certainty of evidence. Results: 433 studies were founded after duplicated to be removed. Seven studies were select, and four of them, observational studies with good agreement, methodological and report quality. Metanalysis of four prospective cohort studies were performed, finding an increased risk of postoperative respiratory complications when using NMBA (RR: 2,71 with IC95% 1,99-3,69). Other adverse events of interest could not be evaluated. Conclusions: There is evidence that suggest an increased risk of postoperative respiratory complications when NMBA were used. To establish causality, controlled trials should be performed. There is not enough information about other adverse events.