Effect of Neuromuscular Blockade on Pulmonary Complications in Elective Cardiac Surgery
| Status: | Completed |
|---|---|
| Conditions: | Hospital |
| Therapuetic Areas: | Other |
| Healthy: | No |
| Age Range: | 18 - 90 |
| Updated: | 7/19/2018 |
| Start Date: | March 2016 |
| End Date: | September 15, 2017 |
Prospective, Randomized Trial Comparing Effect of General Anesthesia With and Without Neuromuscular Blockade on Postoperative Pulmonary Complications in Elective Cardiac Surgical Patients
The investigators will conduct a prospective, randomized trial to assess the impact of
neuromuscular blockade on early (<72 hours post-ICU admission) postoperative respiratory
complications in cardiac surgical patients. The study will compare continual neuromuscular
blockade with cisatracurium to a single dose of succinylcholine during general anesthesia for
cardiac surgery.
neuromuscular blockade on early (<72 hours post-ICU admission) postoperative respiratory
complications in cardiac surgical patients. The study will compare continual neuromuscular
blockade with cisatracurium to a single dose of succinylcholine during general anesthesia for
cardiac surgery.
Residual neuromuscular blockade during the immediate postoperative period is an important
patient safety issue. Although used to facilitate the technical performance of surgery,
clinical studies have associated neuromuscular blockade (NMB) with increased incidence of
postoperative respiratory complications. This effect is likely mediated by residual
neuromuscular blockade interfering with airway tone and respiratory effort, leading to
postoperative pneumonia, atelectasis or aspiration. However, the vast majority of these
studies have involved non-cardiac patient populations, yet patients undergoing cardiac
surgery are even more susceptible to the detrimental effects of residual neuromuscular
blockade for a number of reasons. Despite widespread utilization of paralysis during cardiac
surgery, very little is known about residual neuromuscular blockade in patients following
cardiac surgery. Previously published clinical studies date from over a decade ago or are
based on retrospective databases from non-cardiac surgery patients, precluding generalizable
conclusions. Given the substantial role of neuromuscular blockade in the traditional
management of cardiac surgical patients, prospective data is needed to determine the veracity
of this association as well as the surgical tolerability of protocols that minimize
intraoperative paralysis. The investigators will conduct a prospective, randomized trial to
assess impact of neuromuscular blockade on early (<72 hours post-ICU admission) postoperative
respiratory complications.
patient safety issue. Although used to facilitate the technical performance of surgery,
clinical studies have associated neuromuscular blockade (NMB) with increased incidence of
postoperative respiratory complications. This effect is likely mediated by residual
neuromuscular blockade interfering with airway tone and respiratory effort, leading to
postoperative pneumonia, atelectasis or aspiration. However, the vast majority of these
studies have involved non-cardiac patient populations, yet patients undergoing cardiac
surgery are even more susceptible to the detrimental effects of residual neuromuscular
blockade for a number of reasons. Despite widespread utilization of paralysis during cardiac
surgery, very little is known about residual neuromuscular blockade in patients following
cardiac surgery. Previously published clinical studies date from over a decade ago or are
based on retrospective databases from non-cardiac surgery patients, precluding generalizable
conclusions. Given the substantial role of neuromuscular blockade in the traditional
management of cardiac surgical patients, prospective data is needed to determine the veracity
of this association as well as the surgical tolerability of protocols that minimize
intraoperative paralysis. The investigators will conduct a prospective, randomized trial to
assess impact of neuromuscular blockade on early (<72 hours post-ICU admission) postoperative
respiratory complications.
Inclusion Criteria:
- Elective cardiac surgery (CABG, valve replacement, CABG + valve) requiring
cardiopulmonary bypass
Exclusion Criteria:
- Emergency surgery
- Extremes of age
- Previous cardiac surgery
- Clinical contraindications to succinylcholine or cisatracurium
- Anticipated difficult tracheal intubation
- Preoperative mechanical ventilation
- Preoperative pharmacologic/mechanical hemodynamic support
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