Atracurium during thoracic surgery: impaired efficiency in septic processes.


OBJECTIVE The aim of the study was to examine whether the neuromuscular blocking potency of atracurium changes in patients with a septic intrathoracic process. DESIGN Prospective clinical study. SETTING Community hospital. PARTICIPANTS Thirty patients who underwent thoracic surgery for resection of a pulmonary carcinoma were examined. Fifteen patients showed typical signs of a concomitant bacterial superinfection (infection group), 15 age-matched patients without infection served as the control (no-infection) group. INTERVENTIONS Relaxation was induced with atracurium, 0.6 mg/kg intravenously for intubation, followed by a continuous infusion to maintain a 90% neuromuscular blockade. Relaxometry was performed electromyographically using the Datex Relaxograph by stimulating the ulnar nerve next to the wrist. MEASUREMENTS AND MAIN RESULTS The onset time was significantly longer (5.3 +/- 2.9 v 3.3 +/- 1.2 minutes; p < 0.05), and the recovery phase (DUR 10%) was significantly shorter (23.5 +/- 8.6 v 36.9 +/- 7.3 minutes; p < 0.001) in the infection group compared with the controls. The infusion rate within the first hour of continuous application was 77.4% higher in the infection group than in the control group (11.0 +/- 2.9 v 6.2 +/- 1.0 microg/kg/min; p < 0.001). CONCLUSION The study showed that septic intrathoracic processes cause a clear reduction of the neuromuscular blocking potency of atracurium. To guarantee adequate muscle relaxation in such cases, precise neuromuscular monitoring is highly advisable.


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