Vol. 49 | No. 1 | January-June 2021 Back

Open Access

The Occurrence of Postoperative Residual Curarization among Post-Coronary Artery Bypass Graft Patients in a Surgical Intensive Care Unit of a Tertiary Hospital

Marion R. Nuevo, Florian R. Nuevo
Jun 2021 DOI 10.69944/pjc.18ce86517f

Abstract

BACKGROUND: Intermediate-acting muscle relaxants have gained favor in fast-track cardiac  anesthesia since these are associated with early extubation. However, postoperative residual  curarization (PORC) still occur in the post anesthesia care unit. This study aims to determine the  occurrence of PORC among post-coronary artery bypass graft (CABG) patients in the surgical  intensive care units (SICU) of the Philippine Heart Center. 

METHODS: A cross-sectional study was undertaken among 60 patients for elective CABG  surgery. Within an hour from SICU arrival, Train of Four (TOF) ratio was obtained and a value of  <0.7 signified the presence of PORC. 

RESULTS: 57 out of 60 (95%) were found to have PORC. Patients without PORC were  significantly warmer (36.4oC vs 34.8oC, p-value=0.019) upon SICU arrival compared to those  with PORC. The duration of ventilatory support was significantly longer in those with PORC  (510 min vs 305 mins, p-value=0.021). The rocuronium induction dose and duration of infusion  did not differ between those with and without PORC while the use of reversal drug was seen to  significantly prevent its occurrence (p-value=0.003). 

CONCLUSION: This study showed a high incidence of PORC among post-CABG patients in the  SICU with the current practice of Rocuronium infusion during surgery. The use of muscle relaxant  reversal drug was seen to significantly prevent the development of PORC while higher body  temperature upon SICU arrival was observed in patients that did not develop PORC. This study  was also able to show that the development of PORC prolonged post-operative mechanical  ventilatory support hindering the goals of fast-track cardiac surgery.

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