Omission of Muscle Relaxants Is Another Clinically Available Alternative in Fast-Track Cardiac Anesthesia

To the Editor: Concluding their article on fast-track cardiac anesthesia, Murphy et al. (1) list methods to reduce prolonged postoperative muscle blockade. Included were intermediate-acting muscle relaxants, blockade monitoring, routine examinations before extubation, and drug reversal. The authors omitted another clinically available alternative: omission of muscle relaxants. The impression from our fast-track cardiac anesthesia program is that once intubation has been facilitated with succinylcholine, the operation requires no muscle relaxation. Our ability to forego intraoperative muscle relaxants may reflect the collegial relations with our surgeons who appreciate our efforts to render their patients both extubatable and comfortable as rapidly as possible after operation. I recommend this approach to reduce unwanted postoperative muscle blockade in this patient population.