1
|
Prophylactic Penehyclidine Inhalation for Prevention of Postoperative Pulmonary Complications in High-risk Patients: A Double-blind Randomized Trial. Anesthesiology 2022; 136:551-566. [PMID: 35226725 DOI: 10.1097/aln.0000000000004159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postoperative pulmonary complications are common. Aging and respiratory disease provoke airway hyperresponsiveness, high-risk surgery induces diaphragmatic dysfunction, and general anesthesia contributes to atelectasis and peripheral airway injury. This study therefore tested the hypothesis that inhalation of penehyclidine, a long-acting muscarinic antagonist, reduces the incidence of pulmonary complications in high-risk patients over the initial 30 postoperative days. METHODS This single-center double-blind trial enrolled 864 patients age over 50 yr who were scheduled for major upper-abdominal or noncardiac thoracic surgery lasting 2 h or more and who had an Assess Respiratory Risk in Surgical Patients in Catalonia score of 45 or higher. The patients were randomly assigned to placebo or prophylactic penehyclidine inhalation from the night before surgery through postoperative day 2 at 12-h intervals. The primary outcome was the incidence of a composite of pulmonary complications within 30 postoperative days, including respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, and aspiration pneumonitis. RESULTS A total of 826 patients (mean age, 64 yr; 63% male) were included in the intention-to-treat analysis. A composite of pulmonary complications was less common in patients assigned to penehyclidine (18.9% [79 of 417]) than those receiving the placebo (26.4% [108 of 409]; relative risk, 0.72; 95% CI, 0.56 to 0.93; P = 0.010; number needed to treat, 13). Bronchospasm was less common in penehyclidine than placebo patients: 1.4% (6 of 417) versus 4.4% (18 of 409; relative risk, 0.327; 95% CI, 0.131 to 0.82; P = 0.011). None of the other individual pulmonary complications differed significantly. Peak airway pressures greater than 40 cm H2O were also less common in patients given penehyclidine: 1.9% (8 of 432) versus 4.9% (21 of 432; relative risk, 0.381; 95% CI, 0.171 to 0.85; P = 0.014). The incidence of other adverse events, including dry mouth and delirium, that were potentially related to penehyclidine inhalation did not differ between the groups. CONCLUSIONS In high-risk patients having major upper-abdominal or noncardiac thoracic surgery, prophylactic penehyclidine inhalation reduced the incidence of pulmonary complications without provoking complications. EDITOR’S PERSPECTIVE
Collapse
|
2
|
Zhu L, Shi X, Yin S, Yin J, Zhu Z, Gao X, Jiao Y, Yu W, Yang L. Effectiveness and pulmonary complications of perioperative laryngeal mask airway used in elderly patients (POLMA-EP trial): study protocol for a randomized controlled trial. Trials 2019; 20:260. [PMID: 31068221 PMCID: PMC6505282 DOI: 10.1186/s13063-019-3351-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 04/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background With the increasing amount of geriatric surgery, it has become a great challenge for anesthesiologists to reduce the incidence of postoperative pulmonary complications (PPCs). The two most popular airway management methods, laryngeal mask airway (LMA) and endotracheal intubation (ETI), both have their unique advantages in specific clinical settings. For the purpose of helping clinicians make better decisions on airway management during geriatric surgery, we designed this multi-center clinical trial to compare the influence of LMA and ETI on PPCs. Methods/design In this multi-center, randomized, parallel clinical trial, a total of 6000 elderly patients, aged ≥ 70 years, with an American Society of Anesthesiologists classification level of 1–2 and a body mass index ≤ 35 kg/m2, undergoing elective surgery will be enrolled and randomized into the LMA or the ETI group. Both groups will receive usual perioperative care except for the adoption of LMA/ETI. Primary outcomes are the occurrence of PPCs and patients’ perioperative mortality rates. Ease of intubation, anesthetics consumption, treatment for PPCs, duration of surgery, anesthesia recovery time and performance, time of PPC onset, postanesthesia care unit stay, intensive care unit admission and stay, in-hospital days, re-admission rates, hospitalization cost, and patients’ satisfactory scores will be secondary outcomes. Follow-up will be conducted through phone-call visits until 12 weeks after discharge. Discussion This trial will assess the possible benefits or disadvantages of perioperative LMA use in elderly patients compared with ETI regarding the occurrence of PPCs and clinical prognosis. We expect that this trial will also add to the current understanding of PPCs in geriatric populations and contribute to the international recommendations of geriatric surgery management. Trial registration ClinicalTrials.gov, NCT02240901. Registered on 16 September 2014. Electronic supplementary material The online version of this article (10.1186/s13063-019-3351-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ling Zhu
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai, 200127, China
| | - Xiao Shi
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai, 200127, China
| | - Suqing Yin
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai, 200127, China
| | - Jiemin Yin
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai, 200127, China
| | - Ziyu Zhu
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai, 200127, China
| | - Xiong Gao
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai, 200127, China
| | - Yingfu Jiao
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai, 200127, China
| | - Weifeng Yu
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai, 200127, China.
| | - Liqun Yang
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 Pujian Road, Shanghai, 200127, China.
| |
Collapse
|