Anesth Analg 2004;99:1330-1333
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000132984.56312.FF
CARDIOVASCULAR ANESTHESIA
Is Muscle Relaxant Necessary for Cardiac Surgery?
G. Gueret, MD,
B. Rossignol, MD,
G. Kiss, MD,
J. P. Wargnier, MD,
A. Miossec, MD,
S. Spielman, MD, and
C. C. Arvieux, MD PhD
Département d’Anesthésie Réanimation, Centre Hospitalier la Cavale Blanche, Brest, France
Address correspondence and reprint requests to G. Gueret, MD, Département d’Anesthésie Réanimation, CHU la Cavale Blanche, 29609 Brest, France. Address e-mail to gildas.gueret{at}chu-brest.fr
The need for continuous and complete paralysis during the entire cardiac surgery has not yet been investigated and is still controversial. In a series of 87 patients undergoing cardiac surgery with normothermic cardiopulmonary bypass, we studied the delay of recovery, incidence of residual paralysis, unwanted patient movement, and difficult surgical conditions after a single dose of atracurium (0.5 mg/kg) or cisatracurium (0.15 mg/kg). Anesthesia was induced with etomidate and remifentanil followed by tracheal intubation. The delay to obtain a train-of-four ratio of >0.9 was longer with cisatracurium than with atracurium (86 ± 18 versus 97 ± 19 min). However, at the end of surgery, this ratio was >0.9 for all patients. The presence of unwanted patient movement, diaphragmatic contractions, and difficult surgical conditions were observed. Delay of extubation of the trachea was similar in both groups. We conclude that there is no need for continuous neuromuscular blockade during cardiac surgery. A single dose of either atracurium or cisatracurium is sufficient to provide efficient paralysis from the start of induction leading to quicker recovery from paralysis in fast-track cardiac surgery.
IMPLICATIONS: Residual paralysis as a result of repetitive doses or continuous administration of muscle relaxants is counterproductive for fast-track cardiac surgery which aims for early postoperative extubation and quick recovery. Perioperative patient movement, unwanted diaphragmatic contractions, difficult surgical conditions, and residual paralysis were prevented in 87 patients undergoing cardiac surgery by injecting a single dose of either atracurium or cisatracurium during induction of anesthesia. This practice has no negative impact on surgery and allows early and safe extubation of the trachea.
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