Rocuronium is associated with an increased risk of reintubation in patients with soft tissue infections

Study Objective: To determine risk factors associated with reintubations in adult patients with soft tissue infections. Design: A retrospective case-control design. Setting: Operating room and postoperative recovery area. Patients: There were 39 patients who presented for surgical intervention of their soft tissue infection and 222 controls having general surgery who were matched for age, sex, and body mass index. All patients were older than the age of 18 years and mostly American Society of Anesthesiologists physical status of III to IV and presented to our level 1 trauma center. Interventions: Reintubation within 2 hours after planned extubation. Measurements: The following data were collected: reintubation rates, train of four ratio, reversal agents, age, sex, creatinine, smoking history, transfusion requirements, Sequential Organ Failure Assessment score, hemoglobin, and lactate. Main Results: The use of rocuronium was independently associated with increased odds of reintubation. Patients with a higher train of four ratio were more likely to be reintubated and less likely to be reversed as compared to those with a lower train of four ratio. Conclusions: Soft tissue patients who have received rocuronium are at increased risk for reintubation, particularly those with renal failure. In addition, this article supports the use of neuromuscular blockade reversals, even in patients with a strong train of four ratio. (C) 2016 Elsevier Inc. All rights reserved.