Abstract
Purpose
To determine the incidence of residual neuromuscular blockade after cardiac surgery in patients receiving either rocuronium or pancuronium for muscle relaxation.
Methods
In a prospective, controlled, double-blind study, 20 patients undergoing coronary artery bypass were randomized to receive either rocuronium (n= 10) or pancuronium (n = 10) dunng surgery. Anaesthesia was induced with sufentanil, benzodiazepine and propofol or ketamine, and maintained with air/O2/sufentanil/isoflurane. Neuromuscular blockade was induced with 0.1 ml·kg−1 from blinded synnges containing rocuronium (6 mg·ml−1) (Group R) or pancuronium (I mg·ml−1) (Group P). Relaxants were administered according to clinical criteria and reversal agents were not given. After surgery, neuromuscular transmission was assessed by train-of-four stimulation of the ulnar nerve/adductor pollicis EMG (Datex Relaxograph). Mean values from three trains of stimuli were recorded and repeated 30 min later if TOF ratio was < 0.7. Time to extubation was recorded.
Results
On arrival in the ICU, nine of 10 patients in group R but only three of 10 patients in group P demonstrated four visible responses (P < 0.05). Mean TOF ratio in group P, 0.03 ± 0.05, was less than in group R, 0.68 ± 0.34 (P < 0.001). All patients in group P and 4 of 10 patients in group R had TOF ratio < 0.7 (P = 0.01). Time to extubation in group P (median 18, range 6–48 hr) was not statistically different from that in group R (14, 5–44 hr).
Conclusion
Residual neuromuscular block, TOF ratio < 0.7, is common after cardiac surgery but the incidence is less when pancuronium is replaced by rocuronium.
Résumé
Objectif
Comparer après une chirurgie cardiaque l’incidence de la curansation résiduelle secondaire au rocuronium avec celle du pancuronium.
Méthodes
Cette étude prospective, contrôlée et en double insu regroupait 20 patients opérés pour une chirurgie de revasculansation coronaire. Les patients étaient répartis aléatoirement pour recevoir sort rocuronium (n = 10) soit pancuronium (n= 10) pendant la chirurgie. L’anesthésie était induite au sufentanil, benzodiazépine et propofol ou kétamine et entretenue avec air/O2/sufentanil/isoflurane. La curansation était induite à l’aveugle avec 0.1 ml·ml−1 provenant de seringues contenant du rocuronium (6 mg·ml−1) (Groupe R) ou pancuronium (I mg·ml−1) (Groupe P). On administrait les relaxants conformément aux critères cliniques et on n’utilisait pas d’antagonistes. Après la chirurgie, la transmission neuromusculaire nerf cubital-adducteur du pouce était évaluée avec la stimulation électromyographique au train-de-quatre (TOF: Datex Relaxograph). La valeur moyenne de trois trains de stimulations était enregistrée et répétée 30 min plus tard si la valeur du TOF était < 0,7. Le délai de l’extubation était noté.
Résultats
À l’arrivée à l’unité de soins intensifs, neuf des dix patients du groupe R mais seulement trois du groupe P avait quatre réponses visibles (P < 0,05). Le rapport TOF moyen du groupe R 0.03 ± 0.05 était inférieur à celui du groupe R, 0.68 ± 0.34 (P < 0.001). Tous les patients du groupe P et quatre des dix patients du groupe R avait un rapport TOF < 0.7 (P = 0.001). Le délai d’extubation dans le groupe P (médiane 18. écart 6–48 h) ne différait pas statistiquement de celui du groupe R (14. 5–44 h).
Conclusion
La curansation résiduelle définie comme un rapport TOF < 0.7. est fréquente après une chirurgie cardiaque mais son incidence est moindre quand le rocuronium remplace le pancuronium.
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McEwin, L., Mcrrick, P.M. & Bevan, D.R. Residual neuromuscular blockade after cardiac surgery: pancuroniumvs rocuronium. Can J Anaesth 44, 891–895 (1997). https://doi.org/10.1007/BF03013167
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DOI: https://doi.org/10.1007/BF03013167