Skip to main content Accessibility help

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)...



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.


Corresponding author

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


Hide All


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.


Related content

Powered by UNSILO

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)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.