Postoperative residual curarisation is still an issue when weaning patients in intensive care following cardiac surgery

Residual curarisation is well recognised after cardiac surgery, particularly after pancuronium1. Magnesium, often used in cardiac anaesthesia to prevent hypertension and arrhythmias, potentiates the action of neuromuscular blocking agents (NMBAs) and may result in prolongation of the neuromuscular blockade. Residual curarisation has become more relevant in the past 20 years with the introduction of fast-tracking after such procedures2. Before applying fast-tracking in our cardiosurgical unit, we sought to determine the incidence of postoperative residual curarisation after a traditional postoperative six-hour sedation period, as practised in our department after cardiac surgery until now. For the intraoperative maintenance of muscle paralysis, anaesthetists in our hospital tend to use repeated doses of NMBAs during surgery. The continuous use of NMBAs during cardiopulmonary bypass to increase tissue oxygen saturation is controversial, and continuous infusions of NMBAs during cardiac surgery are therefore not used anymore in our department.