Recovery of neuromuscular function after cardiac surgery: pancuronium versus rocuronium.
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.


CONCLUSIONS
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.
Murphy
Glenn S
GS
Departments of *Anesthesia and ‡Surgery, Evanston Northwestern Healthcare, Evanston, Illinois; and †Department of Anesthesia, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Szokol
Joseph W
JW
Marymont
Jesse H
JH
Vender
Jeffery S
JS
Avram
Michael J
MJ
Rosengart
Todd K
TK
Alwawi
Eihab A
EA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000732:Androstanols; D000762:Anesthesia Recovery Period; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000139:chemically induced / Q000453:epidemiology; D018482:Muscle, Skeletal / Q000187:drug effects*; D009420:Nervous System / Q000187:drug effects*; D003473:Neuromuscular Nondepolarizing Agents; D010197:Pancuronium; D010243:Paralysis / Q000139:chemically induced; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology; D012121:Respiration, Artificial; D000077123:Rocuronium; D015300:Ventilator Weaning
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D010197:Pancuronium; D000077123:Rocuronium