Use of cisatracurium during fast-track cardiac surgery

We prospectively studied spontaneous recovery from cisatracurium-induced ne uromuscular block in 18 patients scheduled for cardiac surgery, and its sui tability for fast-track cardiac surgery. Neuromuscular block was induced by an i.v. bolus (range 0.15-0.3 mg kg(-1)) and maintained by a continuous in fusion (range 1.1-3.2 mug kg(-1) min(-1)) of cisatracurium until sternal cl osure. In the intensive care unit (ICU), spontaneous recovery was evaluated by the train-of-four (TOF) ratio measured at the adductor pollicis muscle. The ICU medical staff were unaware of the TOF ratios until sedation was st opped. At that time, if the TOF ratio was less than 0.9, sedation was recom menced. On arrival in ICU, all patients had-residual paralysis. The mean ti me to reaching a TOF ratio of at least 0.9 was 102 min (range 74-144 min) a fter discontinuation of the cisatracurium infusion. Fifteen patients (83%) were successfully extubated during the first 8 h after stopping the cisatra curium infusion. Only one patient showed residual paralysis when sedation w as discontinued. These results support the use of cisatracurium as a suitab le neuromuscular blocking agent for fast-track cardiac surgery.