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Postoperative residual curarization with cisatracurium and rocuronium infusions
G Cammu1, L de Baerdemaeker, N den Blauwen
1Ghent University Hospital, Department of Anaesthesia, Belgium. Guy.Cammu@olvz-aalst.be
European Journal of Anaesthesiology
|May 10, 2002
Summary
Postoperative residual curarization is common with cisatracurium or rocuronium infusions without antagonism. When reversal is not attempted, cisatracurium appears safer than rocuronium for neuromuscular blockade recovery.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Clinical judgment often guides neuromuscular blockade monitoring.
- Significant national variations exist in the use of reversal agents.
Purpose of the Study:
- To investigate recovery characteristics and postoperative residual curarization after cisatracurium and rocuronium infusions.
- To compare these agents during long duration interventions without routine antagonism.
Main Methods:
- 30 patients received either cisatracurium or rocuronium infusions during propofol anesthesia.
- Infusions were stopped at surgical closure; spontaneous recovery was monitored.
- Neostigmine was administered only if the train-of-four (TOF) ratio did not reach 0.9 upon patient awakening.
Main Results:
- High incidence of residual neuromuscular blockade observed in both groups when antagonism was not systematically applied.
- At the end of surgery, TOF ratios were 51% (cisatracurium) and 47% (rocuronium).
- Neostigmine was required in 40% of cisatracurium patients and 47% of rocuronium patients.
Conclusions:
- Patients receiving cisatracurium or rocuronium infusions face a high risk of postoperative residual curarization without antagonism.
- Cisatracurium may offer a safer profile than rocuronium when neuromuscular blockade reversal is not performed.