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Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury

BACKGROUND: Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. METHODS: This was a single-center, retrospective, electron...

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Autores principales: Smith, Joshua D., Mentz, Graciela, Leis, Aleda M., Yuan, Yuan, Stucken, Chaz L., Chinn, Steven B., Casper, Keith A., Malloy, Kelly M., Shuman, Andrew G., McLean, Scott A., Rosko, Andrew J., Prince, Mark E. P., Tremper, Kevin K., Spector, Matthew E., Schechtman, Samuel A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10375630/
https://www.ncbi.nlm.nih.gov/pubmed/37507689
http://dx.doi.org/10.1186/s12871-023-02217-7
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author Smith, Joshua D.
Mentz, Graciela
Leis, Aleda M.
Yuan, Yuan
Stucken, Chaz L.
Chinn, Steven B.
Casper, Keith A.
Malloy, Kelly M.
Shuman, Andrew G.
McLean, Scott A.
Rosko, Andrew J.
Prince, Mark E. P.
Tremper, Kevin K.
Spector, Matthew E.
Schechtman, Samuel A.
author_facet Smith, Joshua D.
Mentz, Graciela
Leis, Aleda M.
Yuan, Yuan
Stucken, Chaz L.
Chinn, Steven B.
Casper, Keith A.
Malloy, Kelly M.
Shuman, Andrew G.
McLean, Scott A.
Rosko, Andrew J.
Prince, Mark E. P.
Tremper, Kevin K.
Spector, Matthew E.
Schechtman, Samuel A.
author_sort Smith, Joshua D.
collection PubMed
description BACKGROUND: Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. METHODS: This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. RESULTS: Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). CONCLUSIONS: In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-023-02217-7.
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spelling pubmed-103756302023-07-29 Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury Smith, Joshua D. Mentz, Graciela Leis, Aleda M. Yuan, Yuan Stucken, Chaz L. Chinn, Steven B. Casper, Keith A. Malloy, Kelly M. Shuman, Andrew G. McLean, Scott A. Rosko, Andrew J. Prince, Mark E. P. Tremper, Kevin K. Spector, Matthew E. Schechtman, Samuel A. BMC Anesthesiol Research BACKGROUND: Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. METHODS: This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 – 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth’s estimation given low prevalence of the primary outcome. RESULTS: Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 – 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 – 5.51, p = 0.26). CONCLUSIONS: In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-023-02217-7. BioMed Central 2023-07-28 /pmc/articles/PMC10375630/ /pubmed/37507689 http://dx.doi.org/10.1186/s12871-023-02217-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Smith, Joshua D.
Mentz, Graciela
Leis, Aleda M.
Yuan, Yuan
Stucken, Chaz L.
Chinn, Steven B.
Casper, Keith A.
Malloy, Kelly M.
Shuman, Andrew G.
McLean, Scott A.
Rosko, Andrew J.
Prince, Mark E. P.
Tremper, Kevin K.
Spector, Matthew E.
Schechtman, Samuel A.
Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
title Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
title_full Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
title_fullStr Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
title_full_unstemmed Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
title_short Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
title_sort use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10375630/
https://www.ncbi.nlm.nih.gov/pubmed/37507689
http://dx.doi.org/10.1186/s12871-023-02217-7
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