Objectives
The authors investigated the management of neuromuscular blocking agents (NMBAs) for
pediatric patients after cardiac surgery, and compared the outcomes of patients who
received prophylactic NMBA (pNMBA) infusions and patients without pNMBA infusions.
Design
A retrospective cohort study.
Setting
At a tertiary teaching hospital.
Participants
Patients younger than 18, with congenital heart disease, who underwent cardiac surgery.
Interventions
Commencement of NMBA infusion in the first 2 hours after surgery
Measurements and Main Results
The primary endpoint was a composite of one or more of the following major adverse
events (MAEs) that occurred within 7 days after surgery: death from any cause, a circulatory
collapse that needed cardiopulmonary resuscitation, and requirement for extracorporeal
membrane oxygenation. The secondary endpoints included the total duration of mechanical
ventilation for the first 30 days after surgery. A total of 566 patients were included
in this study. The MAEs occurred in 13 patients (2.3%). An NMBA was commenced within
2 hours after surgery in 207 patients (36.6%). There were significant differences
in the incidence of postoperative MAEs between the pNMBA group and the non-pNMBA group
(5.3% v 0.6%; p < 0.001). In multivariate regression models, pNMBA infusion was not significantly
associated with the incidence of MAEs (odds ratio: 1.79, 95% CI: 0.23-13.93, p = 0.58),
but was significantly associated with prolonged mechanical ventilation by 3.85 days
(p < 0.001).
Conclusions
Postoperative prophylactic neuromuscular blockade after cardiac surgery can be associated
with prolonged mechanical ventilation, but has no association with MAEs among pediatric
patients with congenital heart disease.
Key Words
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References
- Neuromuscular blocking agents in paediatric anaesthesia.Br J Anaesth. 1999; 83: 58-64
- Neuromuscular blocking agents in ARDS.N Engl J Med. 2010; 363: 1176-1180
- Sedation and neuromuscular blockade in paediatric intensive care; practice in the United Kingdom and North America.Paediatr Anaesth. 2004; 14: 439-442
- Effect of neuromuscular blockade on oxygen consumption and energy expenditure in sedated, mechanically ventilated children.Crit Care Med. 2000; 28: 1569-1571
- Spectrum of current management of pediatric pulmonary hypertensive crisis.Crit Care Explor. 2019; 1: e0037
- [Postoperative respiratory care in congenital heart disease with pulmonary hypertension–continuous muscle relaxation therapy].Kyobu Geka. 1986; 39 (880-9)
- Pediatric pulmonary hypertension: Guidelines from the American Heart Association and American Thoracic Society.Circulation. 2015; 132: 2037-2099
- Clinical review: Intensive care unit acquired weakness.Crit Care. 2015; 19: 274
- Sedation, analgesia, and neuromuscular blockade in sepsis: An evidence-based review.Crit Care Med. 2004; 32: S554-S561
- Respiratory weakness is associated with limb weakness and delayed weaning in critical illness.Crit Care Med. 2007; 35: 2007-2015
- Critical illness polyneuropathy: Risk factors and clinical consequences. A cohort study in septic patients.Intensive Care Med. 2001; 27: 1288-1296
- Reversal of residual neuromuscular block: Complications associated with perioperative management of muscle relaxation.Br J Anaesth. 2017; 119: i53-i62
- Sedation, analgesia, and neuromuscular blockade: An assessment of practices from 2009 to 2016 in a national sample of 66,443 pediatric patients cared for in the ICU.Pediatr Crit Care Med. 2020; 21: e599-e609
- Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass.Pediatr Crit Care Med. 2010; 11: 234-238
- An empirically based tool for analyzing mortality associated with congenital heart surgery.J Thorac Cardiovasc Surg. 2009; 138: 1139-1153
- Pulmonary hypertension after operations for congenital heart disease: Analysis of risk factors and management.J Thorac Cardiovasc Surg. 1996; 112 (1600-7; discussion 1607-9)
- Clinical pharmacokinetics of the newer neuromuscular blocking drugs.Clin Pharmacokinet. 1999; 36: 169-189
- Current United Kingdom sedation practice in pediatric intensive care.Paediatr Anaesth. 2007; 17: 675-683
- 2020 ESC Guidelines for the management of adult congenital heart disease.Eur Heart J. 2021; 42: 563-645
- Predictors of low exercise cardiac output in patients with severe pulmonic regurgitation.Heart. 2021; 107: 223-228
- Analysis of risk factors of low cardiac output syndrome after congenital heart disease operation: What can we do.J Cardiothorac Surg. 2021; 16: 135
- Preventing pulmonary hypertensive crisis in the pediatric patient after cardiac surgery.Am J Crit Care. 1995; 4 (quiz 54-45): 49-53
- Ultrasound assessment of ventilator-induced diaphragmatic dysfunction in mechanically ventilated pediatric patients.Paediatr Respir Rev. 2021; 40: 58-64
- Risk factors for ventilator-associated events in a PICU.Pediatr Crit Care Med. 2018; 19: e7-e13
- Factors associated with pediatric ventilator-associated conditions in six U.S. hospitals: A nested case-control study.Pediatr Crit Care Med. 2017; 18: e536-e545
- Impact of sustained neuromuscular blockade on outcome of mechanically ventilated children.Pediatrics Int. 2010; 52: 438-443
- An evaluation of continuous infusion rocuronium for sustained neuromuscular blockade in critically ill adults.Ann Pharmacother. 2021; 55: 732-737
- Consensus guidelines for sustained neuromuscular blockade in critically ill children.Paediatr Anaesth. 2007; 17: 881-887
- Train-of-four results and observed muscle movement in children during continuous neuromuscular blockade.Crit Care Nurse. 2008; 28 (30-8; quiz 39)
- The effect of neuromuscular blockade on oxygen consumption in sedated and mechanically ventilated pediatric patients after cardiac surgery.Intensive Care Med. 2008; 34: 2268-2272
Article info
Publication history
Published online: February 22, 2023
Publication stage
In Press Corrected ProofIdentification
Copyright
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