Impact of shorter-acting neuromuscular blocking agents on fast-track recovery of the cardiac surgical patient.
BACKGROUND
Residual paralysis associated with the use of long-acting muscle relaxants can delay recovery from anesthesia and surgery. The authors tested the hypothesis that use of shorter-acting neuromuscular blocking agents is associated with reductions in tracheal extubation times and intensive care unit (ICU) length of stay in patients undergoing cardiac surgery with cardiopulmonary bypass.


METHODS
One hundred ten patients scheduled for elective coronary artery bypass grafting or single valve surgery were randomized prospectively to receive either pancuronium or rocuronium intraoperatively. Anesthetic management and muscle relaxant maintenance dosing were standardized. In the ICU, the time required to wean ventilatory support, the duration of tracheal intubation, and length of stay were recorded. Subjects were asked to quantify generalized muscle weakness as they awakened in the ICU and again after tracheal extubation.


RESULTS
Complete data were collected on 51 patients in the pancuronium group and 52 patients in the rocuronium group. No differences were found between the groups in anesthetic, surgical, or ICU management. Significant increases in the duration of weaning of ventilatory support were observed in patients who received pancuronium (median, 180 min; range, 50-780 min) compared with the rocuronium group (median, 110 min; range, 45-250 min). Tracheal extubation was significantly delayed in the pancuronium group (median, 500 min; range, 240-1,305 min) compared with the rocuronium group (median, 350 min; range, 210-1,140 min). Subjects in the pancuronium group experienced more mild to severe weakness in the ICU. However, the choice of muscle relaxant did not influence ICU length of stay.


CONCLUSIONS
The use of shorter-acting neuromuscular blocking agents in patients undergoing cardiac surgery with cardiopulmonary bypass is associated with reductions in tracheal extubation times and symptoms of residual paresis.
Murphy
Glenn S
GS
Department of Anesthesia, Evanston Northwestern Healthcare, Evanston, Illinois 60201, USA. dgmurphy@core.com
Szokol
Joseph W
JW
Marymont
Jesse H
JH
Avram
Michael J
MJ
Vender
Jeffery S
JS
Rosengart
Todd K
TK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000732:Androstanols / Q000009:adverse effects; D000762:Anesthesia Recovery Period; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D003422:Critical Care; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000139:chemically induced; D009407:Nerve Block / Q000009:adverse effects; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects; D010197:Pancuronium / Q000009:adverse effects; D011446:Prospective Studies; D000077123:Rocuronium
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D010197:Pancuronium; D000077123:Rocuronium