Muscle relaxation does not influence venous oxygen saturation during cardiopulmonary bypass

Cammu, Guy; Cardinael, Sara; Lahousse, Sabine; Eecke, G. Ver; Coddens, J.; Foubert, L.; Gooris, Theo; Deloof, Thierry

doi:10.1016/j.jclinane.2006.05.026

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…They found no differences in anesthetic requirements, surgical conditions, or venous oxygen saturation between the two groups. 23 Hence, a similar strategy could minimize the risk of residual paralysis and delayed extubation without impairing initial airway control during fast-track cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Postoperative awake paralysis in the intensive care unit after cardiac surgery due to residual neuromuscular blockade: a case report and prospective observational study

Roy

Morissette

Girard

et al. 2016

Can J Anesth/J Can Anesth

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Postoperative residual paralysis after fast-track cardiac surgery was common in our institution and likely contributed to the reported case of postoperative awake paralysis. We suggest that an NMB not be administered after intubation in fast-track patients. If given, however, it must be well communicated to the ICU team upon ICU admission. We further recommend routine assessment of neuromuscular function before sedation is weaned prior to extubation.

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Section: Discussionmentioning

confidence: 99%

Postoperative awake paralysis in the intensive care unit after cardiac surgery due to residual neuromuscular blockade: a case report and prospective observational study

Roy

Morissette

Girard

et al. 2016

Can J Anesth/J Can Anesth

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“…This small group of patients were undergoing resuscitation at the time of the measurement, and reduction in tissue oxygen debt, rather than the addition of NMBA or mode change, may have accounted for the VO2 changes. NMBA do not seem to influence oxygen consumption in patients undergoing cardiopulmonary bypass [42]. In a double blind cross over study of 18 patients with severe sepsis or septic shock, using vecuronium closed-loop infusion, a defined level of paralysis was able to be achieved [43].…”

Section: Potential Benefits Of Nmbamentioning

confidence: 98%

Neuromuscular Blockade in the Optimal Management of Mechanical Ventilation of Patients with Respiratory Distress

Freebairn¹,

McHugh

2010

CRMR

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Mechanical ventilation is an integral component in the management of patients with acute respiratory failure. The role of neuromuscular junction blocking agents (NMBA) in facilitating mechanical ventilation in intensive care remains controversial. NMBA have been variously advocated to decrease oxygen consumption through reduction of the work of breathing, ablation of shivering and reduction of metabolic rates, as well as to increase oxygen delivery through improved ventilation. Additional attributed benefits include the reduced potential for barotrauma, enhanced ventilatorpatient synchrony, and an ability to reduce the inspired fraction of oxygen. Despite all of these putative benefits, there remains scant high-grade evidence to guide rationale use of NMBA in the critically ill patient. Many Clinical Practice Guidelines recommend that NMBA be avoided due to the associated risk of prolonged neuromuscular weakness. Other adverse effects associated with NMBA use include the consequences of undetected circuit disconnection, reduced neurological signs, risk of awareness and recall in inadequately sedated patients, increased post-traumatic stress disorder, and reduction in supported spontaneous breathing and coughing.Optimal paralysis depth remains empiric and is often poorly controlled or monitored in intensive care. Nonetheless prudent NMBA does not appear to prolong ventilation. Refractory hypoxemia almost invariably leads to the use of NMBA. Intriguingly, systematic use of NMBA for 48 hours appears to have beneficial long-term effects in patients with severe ARDS. Rather than simply targeting short term gain in oxygenation and lung mechanics, this benefit may justify a 2-day period of NMBA use in severe ARDS.

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Anesthesia in Adult Cardiac Surgery without Maintenance of Muscle Relaxants: A Randomized Clinical Trial

Fakhari¹,

Bilehjani²,

Azarfarin³

et al. 2009

Pakistan J. of Biological Sciences

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There may be no need for muscle paralysis during cardiac surgery when adequate anesthesia is provided. We studied intra- and post-operative conditions during cardiac surgery without maintenance muscle relaxant therapy. Eighty adult patients who were candidates for elective coronary artery bypass graft surgery were randomly allocated into two groups. In the noMR or study group (noMR group; n = 40) only an intubation dose of cisatracurium (0.15 mg kg(-1)) was administrated, as opposed to the control group (MR group; n = 40), who had a continuous infusion added to the intubation dose. The anesthesia level was maintained at a Bispectral score of 40-50 using a propofol infusion. A remifentanil infusion was titrated to control patient hemodynamic response. During surgery, any minor (fine body or respiratory muscle movements) or major (coarse body movements or bucking/caught) movements were recorded. Postoperatively, analgesia was provided by remifentanil. The surgical condition was classified into three states: good (no movement), acceptable (minor movements), or poor (major movements). Anesthesia, surgery and postoperative characteristics were compared between the two groups. Statistical analysis was performed in only 78 patients (noMR = 38, MR = 40). The demographic and preoperative characteristics of the two groups were comparable. Intra-operative propofol consumption was the same, but significantly more remifentanil was used in the noMR group (p = 0.001). Post-operative characteristics and complication rates did not differ between the two groups. There were no movements in the MR group patients, while in the noMR group one patient had major movement and three had minor movements. We concluded that omitting maintenance muscle relaxants in adult cardiac surgery or eliminating residual muscle paralysis at the end of the surgery without improving early outcome can increase patient intra-operative movement risk.

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Muscle relaxation does not influence venous oxygen saturation during cardiopulmonary bypass

Cited by 3 publications

References 16 publications

Postoperative awake paralysis in the intensive care unit after cardiac surgery due to residual neuromuscular blockade: a case report and prospective observational study

Postoperative awake paralysis in the intensive care unit after cardiac surgery due to residual neuromuscular blockade: a case report and prospective observational study

Neuromuscular Blockade in the Optimal Management of Mechanical Ventilation of Patients with Respiratory Distress

Anesthesia in Adult Cardiac Surgery without Maintenance of Muscle Relaxants: A Randomized Clinical Trial

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