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CARDIOVASCULAR ANESTHESIA

The Use of Neuromuscular Blocking Drugs in Adult Cardiac Surgery: Results of a National Postal Survey

Glenn S. Murphy, MD^*, Joseph W. Szokol, MD^*, Jeffery S. Vender, MD^*, Jesse H. Marymont, MD^*, and Michael J. Avram, PhD

*Department of Anesthesiology, Evanston Northwestern Healthcare, Illinois; and Department of Anesthesiology, Northwestern University Feinberg School of Medicine (get address)

Address correspondence and reprint requests to Glenn S. Murphy, MD, Department of Anesthesiology, Evanston Northwestern Healthcare, 2650 Ridge Ave., Evanston, IL 60201. Address e-mail to dgmurphy{at}core.com

Available data suggest that the choice of neuromuscular blocking drugs (NMBDs) can influence early clinical recovery of the fast-track cardiac surgical patient. The aim of this study was to use a survey tool to determine practice patterns of anesthesiologists for the use of NMBDs in the cardiac surgical setting. We mailed a survey to one third of the 3295 active members of the Society of Cardiovascular Anesthesiologists. A follow-up letter and survey were sent to each individual who did not respond to the initial mailing. After the second mailing, 459 surveys were returned, yielding a response rate of 43%. Pancuronium was listed as the primary NMBD used in the majority of patients undergoing cardiopulmonary bypass (69%) and off-pump (41%) procedures. Only 28% of respondents routinely used a peripheral nerve stimulator to monitor neuromuscular blockade in the operating room. Residual neuromuscular blockade was routinely reversed before tracheal extubation by only 9% of cardiac anesthesiologists. This survey demonstrates that long-acting NMBDs are often administered to fast-track cardiac patients. Peripheral nerve stimulator monitoring is rarely used in the operating room or intensive care unit, and reversal drugs (anticholinesterases) are infrequently administered in the postoperative period.

IMPLICATIONS:This postal survey of cardiac anesthesiologists demonstrates that long-acting muscle relaxants are frequently administered to fast-track cardiac surgical patients. Neuromuscular blockade is rarely monitored or reversed in this patient population.

This article has been cited by other articles:

				G. S. Murphy, J. W. Szokol, J. H. Marymont, S. B. Greenberg, M. J. Avram, and J. S. Vender Residual Neuromuscular Block and Adverse Respiratory Events Anesth. Analg., November 1, 2008; 107(5): 1756 - 1756. [Full Text] [PDF]

				S. Metz, G. S. Murphy, J. W. Szokol, and J. S. Vender Omission of Muscle Relaxants Is Another Clinically Available Alternative in Fast-Track Cardiac Anesthesia * Response Anesth. Analg., November 1, 2003; 97(5): 1545 - 1546. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999