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Kardiorelax 2011 – a five-day observational study of neuromuscular blockade during adult cardiac surgery in the Czech Republic


Authors: Hájek Roman 1;  Adámek Petr 2;  Derych Leo 3;  Horáček Michal 4;  Jehlička Pavel 5;  Kameník Vladimír 6;  Leitgeb Marián 7;  Mokrejš Jiří 8;  Říha Hynek 9;  Samek Jindřich 10;  Schichel Tomáš 11;  Turek Zdeněk 10;  Vaněk Tomáš 12
Authors‘ workplace: Kardiochirurgická klinika, LF Univerzity Palackého a Fakultní nemocnice Olomouc 1;  Centrum kardiovaskulární a transplantační chirurgie, Brno 2;  Kardiochirurgické oddělení, Nemocnice Podlesí, a. s., Třinec 3;  Klinika anesteziologie, resuscitace a intenzivní medicíny, 2. LF Univerzity Karlovy a Fakultní nemocnice Motol, Praha 4;  Kardiocentrum, Nemocnice Na Homolce, Praha 5;  Klinika anesteziologie, resuscitace a intenzivní medicíny, 1. LF Univerzity Karlovy a Všeobecná fakultní nemocnice, Praha 6;  Kardiocentrum, Nemocnice, a. s., České Budějovice 7;  Kardiochirurgické oddělení, Fakultní nemocnice Plzeň 8;  Klinika anesteziologie a resuscitace, Kardiocentrum, IKEM Praha 9;  Klinika anesteziologie, resuscitace a intenzivní medicíny, LF Univerzity Karlovy a Fakultní nemocnice Hradec Králové 10;  Kardiochirurgické centrum, Fakultní nemocnice Ostrava 11;  Kardiochirurgická klinika, 3. LF Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha 12
Published in: Anest. intenziv. Med., 23, 2012, č. 1, s. 14-20
Category: Anaesthesiology - Original Paper

Overview

Objective:
To obtain data about the use of neuromuscular blocking agents (NMBAs) during general anaesthesia in adult patients undergoing cardiac surgery in the Czech Republic.

Design:
A five-day, prevalence, questionnaire study.

Setting:
All cardiac anesthesia departments that registered before the study date.

Materials and methods:
Patients whose anesthetic care was provided between June 6 (7 AM) and June 11 (7 AM) were enrolled. Data of each patient were entered into a web-based questionnaire and information relevant to neuromuscular blockade was collected.

Results:
During the study period, 183 patients (173 on cardiopulmonary bypass) were anesthetized. Tracheal intubation (172 patients) was facilitated most often by non-depolarizing NMBAs: rocuronium (31.1%), pancuronium (16.9%), atracurium (14.8%), cisatracurium (13.7%), and suxamethonium 2.2%. Neuromuscular blockade was maintained most frequently with rocuronium (24.0%), cisatracurium (15.8%), pancuronium (12.0%), atracurium (14.8%), and vecuronium (11.5%). Neuromuscular blockade was not reversed in any patient. Monitoring of neuromuscular blockade was not used in any patient.

Conclusion:
For induction and maintenance of neuromuscular blockade, predominantly intermediate NMBAs were used. In the Czech Republic, neither neuromuscular blockade monitoring nor pharmacological reversal is used during cardiac surgery in adult patients.

Keywords:
questionnaire survey – neuromuscular blockade – cardiac surgery – neuromuscular blocking agent – reversal – monitoring


Sources

1.  Murphy, G. S., Szokol, J. W., Vender, J. S. The use of neuromuscular blocking drugs in adult cardiac surgery: results of national postal survey. Anesth. Analg., 2002, 95, p. 1534–1539.

2.  Černý, V., Adamus, M., Cvachovec, K., Ševčík, P., Herold, I. Anestezie v České republice 2010 – jednodenní prospektivní observační dotazníková studie. Anest. intenziv. Med., 2011, 22, p. 5–12.

3.  Adamus, M., Herold, I., Cvachovec, K., Ševčík, P., Černý, V. Svalová relaxace během celkové anestezie v České republice 2010 – jednodenní prospektivní observační dotazníková studie. Anest. intenziv. Med., 2011, 22, p. 82–89.

4.  McEwin, L., Merrick, P. M., Bevan, D. R. Residual neuromuscular blockade after cardiac surgery: pancuronium vs rocuronium. Can. J. Anaesth., 1997, 44, p. 891–895.

5.  Murphy, G. S., Szokol, J. W., Marymont, J. H. Impact of shorter-acting neuromuscular blocking agents on fast-track recovery of the cardiac surgical patient. Anesthesiology, 2002, 96, p. 600–606.

6.  Hemmerling, T. M., Russo, G., Bracco, D. Neuromuscular blockade in cardiac surgery: An update for clinicians. Ann. Card. Anaesth., 2008, 11, p. 80–88.

7.  Virmani, S., Tempe, D. K., Datt, V. Effect of muscle relaxants on heart rate, arterial pressure, intubation condition and onset of neuromuscular block in patients undergoing valve surgery. Ann. Card. Anaesth., 2006, 9, p. 37–43.

8.  Cammu, G. How rational is muscle relaxation during cardiac surgery? Acta Anaesthesiol. Belg., 2007, 58, p. 7–14.

9.  Irish, C. L., Murkin, J. M., Cleland, A. Neuromuscular blockade significantly decreases systemic oxygen consumption during hypothermic cardiopulmonary bypass. J. Cardiothorac. Vasc. Anesth., 1991, 5, p. 132–134.

10.  Cammu, G., Cardinael, S., Lahousse, S. Muscle relaxation does not influence venous oxygen saturation during cardiopulmonary bypass. J. Clin. Anesth., 2007, 19, p. 105–109.

11.  Vernon, D. D., Witte, M. K. Effect of neuromuscular blockade on oxygen consumption and energy expenditure in sedated, mechanically ventilated children. Crit. Care Med., 2000, 28, p. 1569–1571.

12.  Lemson, J., Driessen, J. J., van der Hoeven, J. G. The effect of neuromuscular blockade on oxygen consumption in sedated and mechanically ventilated pediatric patients after cardiac surgery. Intensive Care Med., 2008, 34, p. 2268–2272.

13.  Olivieri, L., Piourde, G. Prolonged (more than ten hours) neuromuscular blockade after cardiac surgery. Report of two cases. Can. J. Anaesth., 2005, 52, p. 88–93.

14. Buzzelo, W., Schiuermann, D., Pollmaecher, T. Unequal effects of cardiopulmoary bypass-induced hypothermia on neuromuscular blockade from constant infusion of alcuronium, d-tubocurarine, pancuronium and vecuronium. Anesthesiology, 1987, 66, p. 842–846.

15.  Smeulers, N. J., Vierda, J. M., van den Broek, L. Effects of hypothermic cardiopulmonary bypass on the farmacodynamics and pharmacokinetics of rocuronium. J. Cardiothorac. Vasc. Anaesth., 1995, 9, p. 700–705.

16.  Murphy, G. S., Szokol, J. W., Maymont, J. H. Recovery of neuromuscular function after cardiac surgery: Pancuronium vs rocuronium. Can. J. Anaesth., 1997, 44, p. 891–895.

17. Cammu, G., Coddens, J., Hendrickx, J. Dose requirements of infusions of cisatracurium or rocuronium during hypothermic cardiopulmonary bypass. Br. J. Anaesth., 2000, 84, p. 587–590.

18.  Ouattara, A., Richard, L., Charriere, J. M. Use of cis-atracurium during fast-track cardiac surgery. Br. J. Anaesth., 2001, 86, p. 130–132.

19.  Gueret, G., Rossignol, B., Kiss, G. Is muscle relaxant necessary for cardiac surgery? Anaesth. Analg., 2004, 99, p. 1330–1333.

20. van Vlymen, J. M., Parlow, J. L. The effects of reversal of neuromuscular blockade on autonomic control in the perioperative period. Anesth. Analg., 1997, 84, p. 148–154.

21.  Adamus, M., Gabrhelik, T., Marek, O. Influence of gender on the course of neuromuscular block following a single bolus dose of cisatracurium or rocuronium. Eur. J. Anaesthesiol., 2008, 25: p. 589–595.

22. Kopman, A. F. Neuromuscular monitoring: Old issues, new controversies. J. Crit. Care, 2009, 24, p. 11–20.

23. Fuchs-Buder, T., Schreiber, J.-U., Meistelman, C. Monitoring neuromuscular block: an update. Anaesthesia, 2009, 64, S1, p. 82–89.

24.  Cerny V, Herold I, Cvachovec K, Sevcik P, Adamus M. Guidelines for managing neuromuscular block: not only Czech beer deserves a taste. Anesth. Analg., 2011, 112, p. 482.

25.  Donati, F. Neuromuscular monitoring: what evidence do we need to be convinced? Anesth. Analg., 2010, 111, p. 6–8.

26. Debaene, B., Plaud, B., Dilly, M. P., Donati, F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology, 2003, 98, p. 1042–1048.

27.  Murphy, G., Hessel, E., Groom R. Optimal perfusion during cardiopulmonary bypass: an evidence-based approach. Anesth. Analg., 2009, 108, p. 1394–1417.

Labels
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
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