Use of cisatracurium during fast-track cardiac surgery

Abstract

We prospectively studied spontaneous recovery from cisatracurium-induced neuromuscular block in 18 patients scheduled for cardiac surgery, and its suitability for fast-track cardiac surgery. Neuromuscular block was induced by an i.v. bolus (range 0.15-0.3 mg kg(-1)) and maintained by a continuous infusion (range 1.1-3.2 microg kg(-1) min(-1)) of cisatracurium until sternal closure. In the intensive care unit (ICU), spontaneous recovery was evaluated by the train-of-four (TOF) ratio measured at the adductor pollicis muscle. The ICU medical staff were unaware of the TOF ratios until sedation was stopped. At that time, if the TOF ratio was less than 0.9, sedation was recommenced. On arrival in ICU, all patients had residual paralysis. The mean time to reaching a TOF ratio of at least 0.9 was 102 min (range 74-144 min) after discontinuation of the cisatracurium infusion. Fifteen patients (83%) were successfully extubated during the first 8 h after stopping the cisatracurium infusion. Only one patient showed residual paralysis when sedation was discontinued. These results support the use of cisatracurium as a suitable neuromuscular blocking agent for fast-track cardiac surgery.

Comparison Between Hemodynamic Changes of Atracurium and Cisatracurium in Patients Undergoing Cabg Surgery

“…Cisatracurium, on the other hand, has lower tendency for histamine release, is more potent but with slightly longer onset time and more predictable recovery profile 14 . Its use in cardiac surgery is increasing because of its favorable cardiovascular profile 14 , suitability as adjuvant for fast tracking cardiac surgery 15 and facilitating early extubation after surgery, thus reducing postoperative ICU stay 16 .…”