Cisatracurium in cardiac surgery--continuous infusion vs. bolus administration

The aim of this study was the comparison of infusion vs. intermittent bolus administration of cisatracurium (CA) following cardiac surgery with regard to total intraoperative dose and time of recovery from neuromuscular blockade. From June 2005 to April 2006 sixty ASA II-III patients who were undergoing coronary bypass graft and valve replacement surgery, were equally divided and randomized to receive either intermittent bolus (Group A, n = 30) or continuous infusion (Group B, n = 30) of CA in Madani Heart Center in the Tabriz (Iran). Total intraoperative dose of CA and time to TOF ratio = 0.8 after operation were measured. Anesthesia technique in two groups was the same. All of the patients underwent cardiopulmonary bypass. Intensity of neuromuscular blockade maintained on one train-of-four (TOF) twitch response of adductor pollicis during operation. Mean received dose of CA was 32.8 +/- 20.6 micro/kg/hr in Group A and 89.7 +/- 39.4 micro/kg/hr in Group B (p = 0.003). Total intraoperative dose of CA was 23.6 +/- 4.9 mg in Group A and 39.2 +/- 10.1 mg in Group B (p = 0.001). Spontaneous recovery from neuromuscular blockade in ICU (TOF ratio = 0.8) was reached in 43.8 +/- 9.2 min in Group A, and 64.2 +/- 15.1 min in Group B (p = 0.0001). Intubation time in ICU was not significantly different (Group A = 8.3 +/- 5.1 hrs vs. Group B = 10.2 +/- 6.2 hrs, p = 0.256). These results support the intermittent bolus administration of cisatracurium in cardiac surgery following cardiopulmonary bypass.