Appropriate Use of Neuromuscular Blocking Agents and Reversal Drugs to Enhance Recovery Following Cardiac Surgery

Abstract

To provide a brief review of the use of neuromuscular blocking agents (NMBA) in cardiac surgery, including strategies for reversal and the effects of residual blockade. While ample evidence exists in non-cardiac surgery demonstrating the potential harms of residual neuromuscular blockade (NMB), little is known about the effect on cardiac surgery patients. Few studies have examined whether residual effects are present following cardiac surgery and whether residual NMB has an impact on postoperative outcomes. In non-cardiac surgery, the incidence of residual NMB after surgery is high and associated with pulmonary complications. Anesthesiologists frequently underestimate the incidence of residual NMB in non-cardiac surgery. Objective measurement of the degree of neuromuscular recovery with acceleromyography may be challenging to apply and the monitors are not universally available. Therefore, reversal agents may be underutilized or yield incomplete reversal. As clinicians aim to decrease extubation times following cardiac surgery, the potential implication of residual NMB on perioperative outcomes increases. Research into the incidence and effect of residual NMB on outcomes following cardiac surgery is needed.