Comparison of acceleromyography guided neuromuscular recovery of post cardiac surgery patients with or without using anticholinesterase agent

Pretext: Routine reversal of non depolarizing muscle relaxant neuromuscular blockade is common in practice after general anaesthesia. Neostigmine is most commonly used anticholinesterase agent and it has some serious side effects. We designed observational study to assess if avoidance of pharmacological neuro muscular reversal agents in post cardiac surgery patients with acceleromyographic neuromuscular monitoring (TOF) guided physiological reversal of neuromuscular block can have better recovery profile. Methods and Material: 60 patients who were posted for elective cardiac surgery were divided into two groups (Group S: study group and Group C: control group) of 30 patients each. All patients were managed with institutional protocol peri-opertively, except in recovery period at the time when TOF ratio was more than 0.4, group C patients were given fix dose neostigmine/ glycopyrrolate intravenously while Group S patients were given placebo. All patients were extubated when alertness and TOF ratio of 0.9 achieved. Recovery profile of two groups was compared, using standard statistical analysis by paired t test, annova test and Fisher exact test. Results: Extubation time were significantly longer in group S than group C. (Gr.S 22.3 12.4 min, Gr. C 14.7 9.6 min). Patients of group S remained more stable haemodynamically during extubation than group C (p value 0.039). Group C patients had more but statistically non significant new onset arrhythmias post extubation. Other adverse events like nausea, vomiting and respiratory distress were similar in both the groups. None of the patients from any of the group required reintubation. Lengths of stay in recovery as well as length of stay in hospital was not different between the groups. Conclusions: We concluded that with the guidance of objective neuromuscular monitoring we can physiologically reverse neuro muscular blockade and extubate patients without giving anticholinestersase drugs to group of patients with more stable hemodynamics and avoid possible adverse effect of reversal drugs.