Use of cisatracurium during fast-track cardiac surgery

We prospectively studied spontaneous recovery from cisatracurium-inducedneuromuscular block in 18 patients scheduled for cardiac surgery,and its suitability for fast-track cardiac surgery. Neuromuscularblock was induced by an i.v. bolus (range 0.15–0.3 mgkg^–1) and maintained by a continuous infusion (range 1.1–3.2µg kg^–1 min^–1) of cisatracurium until sternalclosure. In the intensive care unit (ICU), spontaneous recoverywas evaluated by the train-of-four (TOF) ratio measured at theadductor pollicis muscle. The ICU medical staff were unawareof 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. Themean time to reaching a TOF ratio of at least 0.9 was 102 min(range 74–144 min) after discontinuation of the cisatracuriuminfusion. Fifteen patients (83%) were successfully extubatedduring the first 8 h after stopping the cisatracurium infusion.Only one patient showed residual paralysis when sedation wasdiscontinued. These results support the use of cisatracuriumas a suitable neuromuscular blocking agent for fast-track cardiacsurgery. Br J Anaesth 2001; 86: 130–2