{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T01:09:11Z","timestamp":1790989751219,"version":"4.1.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Nondepolarizing neuromuscular blocking agents (ND-NMBAs) are dose-dependently associated with residual paralysis, delayed recovery, and prolonged hospitalization, factors that can predispose patients to postoperative delirium. We hypothesized that neuromuscular blockade is associated with a higher risk of delirium after surgery, and that this can be mitigated by administration of reversal agents.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n In total, 53,772 adult hospitalized patients aged \u226560 years who underwent general anesthesia for noncardiac, nonneurosurgical, nontransplant procedures between 2008 and 2024 at a tertiary health care network in Massachusetts, were included. The exposure was the intraoperative administration of ND-NMBAs. The primary outcome was 7-day delirium, identified from nursing and physician charts using a keyword-based search strategy paired with manual chart review, Confusion Assessment Method assessments, and International Classification of Diseases (9th\/10th Revision, Clinical Modification) diagnostic codes.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n In total, 43,723 (81.3%) patients received neuromuscular blockade. Approximately 2259 (4.2%) patients developed delirium, 1884 (4.3%) with, and 375 (3.7%) without ND-NMBA administration. In adjusted analyses, administration of ND-NMBAs was dose-dependently associated with a higher risk of postoperative delirium (adjusted odds ratio [OR\n adj<\/jats:sub>\n ] 1.15; 95% confidence interval [CI], 1.01\u20131.31;\n P<\/jats:italic>\n = .038 and 1.09; 95% CI, 1.06\u20131.12;\n P<\/jats:italic>\n < .001 per each unit increase in the effective dose required to achieve a 95% twitch reduction). 38,143 (87.2%) patients who received ND-NMBAs also received a reversal agent, which was associated with a lower risk of impaired neuromuscular recovery (preextubation train-of-four ratio <95; OR\n adj<\/jats:sub>\n 0.60; 95% CI, 0.49\u20130.74;\n P<\/jats:italic>\n < .001) and delirium (OR\n adj<\/jats:sub>\n 0.73; 95% CI, 0.64\u20130.83;\n P<\/jats:italic>\n < .001), compared to no reversal. The adverse effect of ND-NMBAs on delirium risk was eliminated by reversal agent administration (OR\n adj<\/jats:sub>\n 1.07; 95% CI, 0.94\u20131.23;\n P<\/jats:italic>\n = .30 with and OR\n adj<\/jats:sub>\n 1.52; 95% CI, 1.28\u20131.79;\n P<\/jats:italic>\n < .001 without reversal agent administration). There was no association between administration of neostigmine, compared to sugammadex, with postoperative delirium (OR\n adj<\/jats:sub>\n 0.91; 95% CI, 0.73\u20131.12;\n P<\/jats:italic>\n = .36).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Neuromuscular blockade during general anesthesia is dose-dependently associated with a higher risk of postoperative delirium. The administration of reversal agents mitigates this risk and might help reduce the occurrence of delirium after surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.1213\/ane.0000000000007489","type":"journal-article","created":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T23:00:08Z","timestamp":1745017208000},"page":"363-372","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":17,"title":["Association Between Neuromuscular Blockade and Its Reversal With Postoperative Delirium in Older Patients: A Hospital Registry Study"],"prefix":"10.1213","volume":"141","author":[{"given":"Elena","family":"Ahrens","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Center for Anesthesia Research Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca J.","family":"Wachtendorf","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Center for Anesthesia Research Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denys","family":"Shay","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Center for Anesthesia Research Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Tenge","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Center for Anesthesia Research Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e9la-Simon","family":"Paschold","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Center for Anesthesia Research Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma\u00edra I.","family":"Rudolph","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"},{"name":"Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Redaelli","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Center for Anesthesia Research Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Center for Anesthesia Research Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiman","family":"Suleiman","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"},{"name":"Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, University of Jordan, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haobo","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp J.","family":"Fassbender","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"},{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Marien Hospital Herne, Bochum University Hospital, Herne, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian S.","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"},{"name":"Center for 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