Year : 2008  |  Volume : 11  |  Issue : 2  |  Page : 80--90

Neuromuscular blockade in cardiac surgery: An update for clinicians

Thomas M Hemmerling, Gianluca Russo, David Bracco 
 Department of Anaesthesiology, McGill University, Montreal General Hospital, Montreal, Canada

Correspondence Address:
Thomas M Hemmerling
Department of Anaesthesiology, Montreal General Hospital, 1650 Cedar Avenue, Montreal, H3G 1B7

There have been great advancements in cardiac surgery over the last two decades; the widespread use of off-pump aortocoronary bypass surgery, minimally invasive cardiac surgery, and robotic surgery have also changed the face of cardiac anaesthesia. The concept of źDQ╗Fast-track anaesthesiaźDQ╗ demands the use of nondepolarising neuromuscular blocking drugs with short duration of action, combining the ability to provide (if necessary) sufficiently profound neuromuscular blockade during surgery and immediate re-establishment of normal neuromuscular transmission at the end of surgery. Postoperative residual muscle paralysis is one of the major hurdles for immediate or early extubation after cardiac surgery. Nondepolarising neuromuscular blocking drugs for cardiac surgery should therefore be easy to titrate, of rapid onset and short duration of action with a pathway of elimination independent from hepatic or renal dysfunction, and should equally not affect haemodynamic stability. The difference between repetitive bolus application and continuous infusion is outlined in this review, with the pharmacodynamic and pharmacokinetic characteristics of vecuronium, pancuronium, rocuronium, and cisatracurium. Kinemyography and acceleromyography are the most important currently used neuromuscular monitoring methods. Whereas monitoring at the adductor pollicis muscle is appropriate at the end of surgery, monitoring of the corrugator supercilii muscle better reflects neuromuscular blockade at more central, profound muscles, such as the diaphragm, larynx, or thoraco-abdominal muscles. In conclusion, cisatracurium or rocuronium is recommended for neuromuscular blockade in modern cardiac surgery.

How to cite this article:
Hemmerling TM, Russo G, Bracco D. Neuromuscular blockade in cardiac surgery: An update for clinicians.Ann Card Anaesth 2008;11:80-90

How to cite this URL:
Hemmerling TM, Russo G, Bracco D. Neuromuscular blockade in cardiac surgery: An update for clinicians. Ann Card Anaesth [serial online] 2008 [cited 2023 Jan 30 ];11:80-90
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