Neuromuscular Monitoring in Anesthesia

Postoperative residual curarization with cisatracurium and rocuronium infusions

Guy Cammu, MD
Anaesthetics & Critical Care Medicine
OLV Clinic, Moorselbaan, B-9300 Aalst,
Belgium

The article also available in PDF: 50 KB

[Editor’s note: This is an abstract of a Clinical Window presentation at the 10th annual ESA/EAA conference in Nice, France (April 2002)].

Background and aim

The monitoring of neuromuscular blockade often still relies on clinical judgement. Moreover, there are substantial national differences in the use of reversal agents. We investigated the recovery characteristics and incidence of postoperative, residual curarisation after cisatracurium and rocuronium infusions for long duration interventions without systematic reversal.

Methods

In 30 patients undergoing major surgery, we measured infusion dose requirements for rocuronium and cisatracurium during propofol anesthesia. Infusions were discontinued at the onset of surgical closure; spontaneous recovery of neuromuscular function was the end point in both groups. Neostigmine (50 µg/kg) was only administered when a patient started to wake without a 0.9 train-of-four ratio.

Results

In the cisatracurium (four patients = 27 %) and (one patient 7 %) rocuronium groups, had a train-of-four ratio of 0.9 at the end of surgery. The train-of-four ratio in each group at that time was 51 ± 32 % for cisatracurium and 47 ± 31 % for rocuronium (P = 0.78). Six patients (40 %) in the cisatracurium group and seven (47 %) in the rocuronium group required neostigmine.

The train-of-four ratio at time of reversal was 63 ± 7 % for cisatracurium and 40 ± 19 % for rocuronium (P = 0.01). The time interval between the end of surgery and the train-of-four ratio of 0.9 was 10 ± 9 min for cisatracurium and 18 ± 13 min for rocuronium (P = ns).

Conclusion

When the block is not antagonised, patients receiving a cisatracurium or rocuronium infusion have a high incidence of postoperative residual curarisation. When reversal is not attempted, cisatracurium seems to be safer than rocuronium. Postoperative residual curarisation can probably be avoided by discontinuing the infusion earlier and/or systemic antagonisation. However, the only reliable method of preventing postoperative residual curarisation is by utilising a quantitative train-of-four evaluation.

Reference

1. Cammu,G.; de Baerdemaeker,L.; den Blauwen,N.; de Mey,J.C.; Struys,M.; Mortier,E. Postoperative residual curarization with cisatracurium and rocuronium infusions. Eur.J.Anaesthesiol. 2002: 19, 129-13
   

Last updated: 1 July 2003Created
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