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British Journal of Anaesthesia, Vol 83, Issue 2 338-339, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia

SHORT COMMUNICATIONS

Residual neuromuscular block caused by pancuronium after cardiac surgery

C. Van Oldenbeek, P. Knowles and NJN. Harper
Department of Anaesthesia, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK

We studied 20 adult patients undergoing cardiac surgery. All received pancuronium as the sole neuromuscular blocking drug and no reversal agent was used. In the postoperative intensive care unit, mechanical ventilation was continued and patients were sedated with an infusion of propofol. Neuromuscular block was measured electromyographically at appropriate intervals until the train-of-four ratio (TOF) reached 0.8. At the time when the propofol infusion would normally be discontinued, 13 patients (65%) demonstrated a TOF of less than 0.8 (group median 0.23, interquartile range 0.11-0.6). Subsequently, the median time to achieve a TOF of 0.8 was 2 h 10 min (interquartile range 1 h-2 h 25 min). We found that if pancuronium was used during cardiac surgery, a significant proportion of patients remained partially paralysed when they would normally be allowed to emerge from anaesthesia in the ICU.
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