Kirmeier E, et al. - In this study performed on 22,803 patients recruited from 211 hospitals in 28 European countries, researchers examined the impact of the use of neuromuscular blocking agents on postoperative pulmonary complications. They included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. They also used logistic regression adjusting for surgical factors and patients' preoperative physical status. Findings revealed an increased risk of postoperative pulmonary complications in association with the use of neuromuscular blocking drugs in general anaesthesia. Anesthesia without neuromuscular blocking agents was administered to only 2·3% of high-risk surgical patients and those with adverse respiratory profiles. Better pulmonary outcomes were not observed both with the choice of sugammadex instead of neostigmine for reversal nor with extubation at a train-of-four ratio of 0·9 or more. Overall, the potential benefits of neuromuscular blockade must be balanced against the increased risk of postoperative pulmonary complications.