Atracurium during thoracic surgery: impaired efficiency in septic processes

Area of Science:

• Anesthesiology and Critical Care Medicine
• Pharmacology
• Thoracic Surgery

Background:

• Septic processes can alter drug pharmacokinetics and pharmacodynamics.
• Atracurium is a commonly used non-depolarizing neuromuscular blocking agent.
• Understanding drug efficacy in infection is crucial for patient management.

Purpose of the Study:

• To investigate the impact of septic intrathoracic processes on the neuromuscular blocking potency of atracurium.
• To determine if infection influences the dose requirements for atracurium during surgery.

Main Methods:

• Prospective clinical study involving 30 patients undergoing thoracic surgery for pulmonary carcinoma.
• Patients were divided into an infection group (n=15) with bacterial superinfection and a control group (n=15) without infection.
• Neuromuscular blockade was induced with atracurium and monitored electromyographically.

Main Results:

• Atracurium onset time was significantly longer in the infection group (5.3 vs. 3.3 minutes).
• Recovery from neuromuscular blockade (DUR 10%) was significantly shorter in the infection group (23.5 vs. 36.9 minutes).
• The atracurium infusion rate required was 77.4% higher in the infection group compared to controls.

Conclusions:

• Septic intrathoracic processes significantly reduce the neuromuscular blocking potency of atracurium.
• Increased doses of atracurium are necessary to achieve adequate neuromuscular blockade in patients with infection.
• Precise neuromuscular monitoring is highly recommended in patients with septic intrathoracic processes to ensure effective muscle relaxation.