Anesthesia in Adult Cardiac Surgery without Maintenance of Muscle Relaxants: A Randomized Clinical Trial
Autor: | A A Kianfar, Moussa Mirinazhad, Sohrab Negargar, Solmaz Fakhari, Rasoul Azarfarin, Eisa Bilehjani |
---|---|
Rok vydání: | 2009 |
Předmět: |
Adult
Male medicine.medical_specialty medicine.drug_class medicine.medical_treatment Remifentanil Tubocurarine Anesthesia General law.invention Intraoperative Period Postoperative Complications Randomized controlled trial law medicine Respiratory muscle Humans Intubation Coronary Artery Bypass Aged Muscle Relaxants Central business.industry Muscle relaxant Middle Aged Surgery Cardiac surgery Anesthesia Female Propofol Complication business Agronomy and Crop Science medicine.drug |
Zdroj: | Pakistan Journal of Biological Sciences. 12:1111-1118 |
ISSN: | 1028-8880 |
Popis: | There may be no need for muscle paralysis during cardiac surgery when adequate anesthesia is provided. We studied intra- and post-operative conditions during cardiac surgery without maintenance muscle relaxant therapy. Eighty adult patients who were candidates for elective coronary artery bypass graft surgery were randomly allocated into two groups. In the noMR or study group (noMR group; n = 40) only an intubation dose of cisatracurium (0.15 mg kg(-1)) was administrated, as opposed to the control group (MR group; n = 40), who had a continuous infusion added to the intubation dose. The anesthesia level was maintained at a Bispectral score of 40-50 using a propofol infusion. A remifentanil infusion was titrated to control patient hemodynamic response. During surgery, any minor (fine body or respiratory muscle movements) or major (coarse body movements or bucking/caught) movements were recorded. Postoperatively, analgesia was provided by remifentanil. The surgical condition was classified into three states: good (no movement), acceptable (minor movements), or poor (major movements). Anesthesia, surgery and postoperative characteristics were compared between the two groups. Statistical analysis was performed in only 78 patients (noMR = 38, MR = 40). The demographic and preoperative characteristics of the two groups were comparable. Intra-operative propofol consumption was the same, but significantly more remifentanil was used in the noMR group (p = 0.001). Post-operative characteristics and complication rates did not differ between the two groups. There were no movements in the MR group patients, while in the noMR group one patient had major movement and three had minor movements. We concluded that omitting maintenance muscle relaxants in adult cardiac surgery or eliminating residual muscle paralysis at the end of the surgery without improving early outcome can increase patient intra-operative movement risk. |
Databáze: | OpenAIRE |
Externí odkaz: |