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Prospective randomised double‐blind comparative study of rocuronium and pancuronium in adult patients scheduled for elective ‘fast‐track’ cardiac surgery involving hypothermic cardiopulmonary bypass
Author(s) -
Thomas R.,
Smith D.,
Strike P.
Publication year - 2003
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1046/j.1365-2044.2003.30362.x
Subject(s) - medicine , rocuronium , cardiopulmonary bypass , anesthesia , neuromuscular monitoring , pancuronium bromide , fast track , adductor pollicis muscle , neuromuscular blockade , cardiac surgery , surgery , intubation , elbow , ulnar nerve
Summary The majority of cardiac anaesthetists in the UK use pancuronium for fast‐track cardiac surgery. We compared the duration of action of pancuronium and rocuronium in patients undergoing fast‐ track hypothermic cardiopulmonary bypass and cardiac surgery. We determined whether patients would have had residual neuromuscular blockade at extubation. Twenty patients were randomly allocated to receive either pancuronium 0.1 mg.kg −1 or rocuronium 1 mg.kg −1 . Neuromuscular function was assessed by acceleromyography; spontaneous recovery was evaluated by the train‐of‐four ratio measured at the adductor pollicis longus muscle. Median times to recover train‐of‐four ratio of 0.9 were 3 h 38 min for rocuronium and 7 h 52 min for pancuronium. The median difference in recovery times was 4 h 15 min (95% CI 2 h 30 min to 6 h 20 min; p = 0.0003 by Mann–Whitney test). None of the patients in the rocuronium group and seven of 10 patients in the pancuronium group had their extubations delayed because of residual neuromuscular blockade. Unless fast‐track patients have neuromuscular function assessed before extubation, pancuronium should not be used.