Comparison of continuous infusion and intermittent bolus administration of Cisatracurium in cardiac surgery: a randomized clinical trial

Objective: The aim of this study was to compare continuous infusion and intermittent bolus administration of cisatracurium (CA) with respect to total intraoperative dose and time of recovery from neuromuscular blockade after cardiac surgery. Methods: From June 2005 to April 2006 sixty patients who undergoing coronary bypass graft and valve replacement surgery were randomized to receive either intermittent bolus (Group A, n=30) or continuous infusion (Group B, n=30) of CA in Madni heart center in Tabriz, Iran.Total intraoperative dose of CA and time to train– of–four (TOF) ratio=0.8 after operation were measured. Anesthesia technique in two groups was the same. Intensity of neuromuscular blockade maintained on one TOF twitch response of adductor pollicis during operation. Results: Mean received dose of CA was 32.8±20.6 μ/kg/hr in Group A and 89.7±39.4μ/kg/hr in Group B (p=0.003). Total intraoperative dose of CA was 23.6±4.9mg in Group A and 39.2±10.1mg in Group B (p=0.001). Spontaneous recovery from neuromuscular blockade in ICU (TOF ratio=0.8) was reached in 43.8±9.2 min in Group A, and 64.2±15.1min in Group B (p=0.0001). Intubation time in ICU was not significantly different (Group A=8.3±5.1hrs vs. Group B=10.2±6.2hrs, p=0.256). Conclusions: Intermittent bolus administration of cisatracurium in cardiac surgery with cardiopulmonary bypass used lower intraoperative dose and gave shorter