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Large bolus dose vs. continuous infusion of cisatracurium during hypothermic cardiopulmonary bypass surgery

  • G. Cammu (a1), V. Boussemaere (a1), L. Foubert (a1), J. Hendrickx (a1), J. Coddens (a1) and T. Deloof (a1)...

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Summary

Background and objective: We investigated whether a high bolus dose of cisatracurium (8× ED95) given at induction can provide muscle relaxation for the major part of a cardiac procedure with hypothermic cardiopulmonary bypass, avoid important postoperative residual curarization and cause no waste of product.

Methods: Twenty patients were randomly assigned either to Group 1 (n = 10) or Group 2 (n = 10). Those in Group 1 were given cisatracurium in a high bolus dose (0.4 mg kg−1). Those in Group 2 received cisatracurium 0.1mg kg−1 at induction followed after 30 min by a continuous infusion of cisatracurium. As an escape medication in case of patient movement, a bolus dose of cisatracurium 0.03 mg kg−1 was given.

Results: In Group 1 (large cisatracurium bolus dose), the clinical duration of effect (until T1/T0 = 25%) was 110 min. Six of 10 patients in Group 1 required additional boluses of cisatracurium intraoperatively. Four of these six had received an additional bolus near the end of surgery and had a train-of-four (TOF) ratio = 0 at the end. The other four patients in Group 1 had a final TOF ratio >0.9. In Group 2 (continuous cisatracurium infusion), only two patients had a TOF ratio >0.9 at the end of surgery, no patient moved and none received additional boluses. The total amount of cisatracurium used in the bolus and infusion Groups was 34.5 ± 7.8 and 21.3 ± 5.7 mg, respectively (P = 0.0004).

Conclusions: For continued neuromuscular block during hypothermic cardiac surgery, a high bolus dose of cisatracurium appears to be safe, although it is not an alternative to a continuous infusion, as its neuromuscular blockade does not cover the intraoperative period and a high incidence of movements occurs. In the patients who received a high bolus dose of cisatracurium, postoperative residual curarization appeared after additional boluses had been given. The consumption of cisatracurium by high bolus was significantly greater than with continuous infusion.

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Correspondence to: Guy Cammu, Department of Anaesthesia and Critical Care Medicine, O.L.V. Clinic, Moorselbaan 164, 9300 Aalst, Belgium. E-mail: Guy.Cammu@olvz-aalst.be; Tel: +32 53 724461; Fax: +32 53 724134

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References

Konstadt SN, Riech DL, Stanley TE, et al. A two-center comparison of the cardiovascular effects of cisatracurium (Nimbex™) and vecuronium in patients with coronary artery disease. Anesth Analg 1995; 81: 10101014.
Rosen DA, Rosen KR. Elimination of drugs and toxins during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1997; 11: 337340.
Flynn PJ, Hughes R, Walton B. Use of atracurium in cardiac surgery involving cardiopulmonary bypass with induced hypothermia. Br J Anaesth 1984; 56: 967972.
Smeulers NJ, Wierda JMKH, Van den Broek L, Gallandat Huet RCG, Hennis PJ. Effects of hypothermic cardiopulmonary bypass on the pharmacodynamics and pharmacokinetics of rocuronium. J Cardiothorac Vasc Anesth 1995; 9: 700705.
Welch RM, Brown A, Ravitch J, Dahl R. The in vitro degradation of cisatracurium, the R, cis-R′-isomer of atracurium, in human and rat plasma. Clin Pharmacol Ther 1995; 58: 132142.
Cammu G, Coddens J, Hendrickx J, Deloof T. Dose requirements of infusions of cisatracurium or rocuronium during hypothermic cardiopulmonary bypass. Br J Anaesth 2000; 84: 587590.
Cammu G, de Baerdemaeker L, den Blauwen N, de Mey JC, Struys M, Mortier E. Postoperative residual curarization with cisatracurium and rocuronium infusions. Eur J Anaesthesiol 2002; 19: 129134.
Bevan DR, Donati F, Kopman AF. Reversal of neuromuscular blockade. Anesthesiology 1992; 77: 785805.
Belmont MR, Lien CA, Quessy S, et al. The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology 1995; 82: 11391145.
Buylaert WA, Herregods L, Mortier E, Bogaert M. Cardiopulmonary bypass and the pharmacokinetics of drugs: an update. Clin Pharmacokinet 1989; 17: 1026.

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Large bolus dose vs. continuous infusion of cisatracurium during hypothermic cardiopulmonary bypass surgery

  • G. Cammu (a1), V. Boussemaere (a1), L. Foubert (a1), J. Hendrickx (a1), J. Coddens (a1) and T. Deloof (a1)...

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