Neuromuscular Blocking Agents in Cardiac Surgery

1. Background: Neuromuscular blocking agents (NMBA) are commonly used in cardiac surgery anesthesia to facilitate airway management and ventilation, and ensure optimal operative conditions. To improve post-operative results and reduce the length of stay in the intensive care unit, the concept of "Fast track anesthesia" is coming into force, which includes all techniques that offer extubation within 1-6 hours post-operatively. Fast-track cardiac surgery is only feasible when short-acting NMBA are used and neuromuscular transmission has returned to normal by the end of the operation or just before extubation, a few hours after surgery. This requires quantitative monitoring of muscle strength, the only way to eliminate residual paralysis defined by a TOF ratio ≥ 0.9. The American Society of Anesthesiologists (ASA) and the European Society of Anesthesiology and Intensive Care (EASIC) recommend quantitative measurement of neuromuscular block until extubation.This is the only way to avoid the complications of residual paralysis, essentially postoperative pulmonary complications. The POPULAR study clearly highlighted the shortcomings of current NMBA management: out of a total population of 17150 patients, only 16.5% were extubated, with a TOF ratio greater than 0.90. Cardiac surgery patients are brought to the ICU still sedated, intubated and ventilated. Neuromuscular blocking agents are usually discontinued at the end of surgery. As awakening and extubation take place later in the ICU, clinicians often consider that the action of neuromuscular blocking agents is over, but without making a quantitative measurement as recommended by the guidelines. 2. Objectives of the clinical research project: 2.1 Primary objective: The primary objective of this single-center prospective observational study is to systematically monitor the degree of postoperative curarization up to the time of extubation, and to assess the degree of adherence of intensive care teams to extubation