This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (7) Citing Articles via Google Scholar Google Scholar Articles by Murphy, G. S. Articles by Alwawi, E. A. Search for Related Content PubMed PubMed Citation Articles by Murphy, G. S. Articles by Alwawi, E. A. Related Collections Cardiovascular Heart Pharmacology

---

CARDIOVASCULAR ANESTHESIA

Recovery of Neuromuscular Function After Cardiac Surgery: Pancuronium Versus Rocuronium

Glenn S. Murphy, MD^*, Joseph W. Szokol, MD^*, Jesse H. Marymont, MD^*, Jeffery S. Vender, MD^*, Michael J. Avram, PhD, Todd K. Rosengart, MD, and Eihab A. Alwawi

Departments of *Anesthesia and Surgery, Evanston Northwestern Healthcare, Evanston, Illinois; and Department of Anesthesia, Northwestern University Feinberg School of Medicine, Chicago, Illinois

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

The use of pancuronium in fast-track cardiac surgical patients may be associated with delays in clinical recovery. Our objective in this study was to evaluate the incidence and severity of residual neuromuscular blockade after cardiac surgery in patients randomized to receive either pancuronium (0.08–0.1 mg/kg) or rocuronium (0.6–0.8 mg/kg). Eighty-two patients undergoing cardiopulmonary bypass were randomized to a pancuronium (n = 41) or rocuronium (n = 41) group. Intraoperative and postoperative management was standardized. In the intensive care unit, train-of-four (TOF) ratios were measured each hour until weaning off ventilatory support was initiated. Neuromuscular blockade was not reversed. After tracheal extubation, patients were examined for signs and symptoms of residual paresis. When weaning of ventilatory support was initiated, significant neuromuscular blockade was present in the pancuronium subjects (TOF ratio: median, 0.14; range, 0.00–1.11) compared with the rocuronium subjects (TOF ratio: median, 0.99; range, 0.87–1.21) (P < 0.05). Patients in the rocuronium group were more likely to be free of signs and symptoms of residual paresis than patients in the pancuronium group. Our findings suggest that the use of longer-acting muscle relaxants in cardiac surgical patients is associated not only with impaired neuromuscular recovery, but also with signs and symptoms of residual muscle weakness in the early postoperative period.

IMPLICATIONS: The use of long-acting muscle relaxants in fast-track cardiac surgical patients is associated with significant residual neuromuscular block in the intensive care unit, including signs and symptoms of residual paresis.

This article has been cited by other articles:

				P. S. Myles and D. McIlroy Fast-Track Cardiac Anesthesia: Choice of Anesthetic Agents and Techniques Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 5 - 16. [Abstract] [PDF]

				G. Gueret, B. Rossignol, G. Kiss, J. P. Wargnier, A. Miossec, S. Spielman, and C. C. Arvieux Is Muscle Relaxant Necessary for Cardiac Surgery? Anesth. Analg., November 1, 2004; 99(5): 1330 - 1333. [Abstract] [Full Text] [PDF]

				C. Weissman Pulmonary Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 185 - 211. [Abstract] [PDF]

				D. J. C. Alders, A. B. J. Groeneveld, F. J. J. de Kanter, and J. H. G. M. van Beek Myocardial O2 consumption in porcine left ventricle is heterogeneously distributed in parallel to heterogeneous O2 delivery Am J Physiol Heart Circ Physiol, September 1, 2004; 287(3): H1353 - H1361. [Abstract] [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]