Abstract
The haemodynamic effects of 200 μg · kg- 1 pipecuronium and pancuronium were compared under etomidate/piritramide anaesthesia in 20 patients scheduled for elective coronary artery surgery. Following the completion of the haemodynamic measurements (ten minutes), anaesthesia was maintained by etomidate/sufentanil infusion. The mean changes in cardiac output were approximately −19 and −2 per cent and in heart rate −1 and +26 per cent for pipecuronium and pancuronium respectively. Plasma and urine concentrations of pipecuronium were also measured and the pharmacokinetic variables obtained indicated rapid initial decrease in plasma concentration (t1/2 = 7.6 minutes) followed by a longer terminal phase (t1/2 = 161 minutes). The central compartment volume was 102 ± 24 ml- kg- 1 and plasma clearance was 1.8 ± 0.4 ml · kg- 1 min- 1. Approximately 56 per cent of the dose was recovered from the urine within 24 hours of administration and about 25 per cent of this was the metabolite, 3-desacetyl pipecuronium. High-dose pipecuronium administration under the anaesthetic regimen employed did not produce deleterious haemodynamic effects. The pharmacokinetic variables after bolus injection of pipecur-onium did not deviate from those reported under normothermic conditions.
Résumé
Nous avons comparé les effets du pipécuronium et du pancuronium à raison de 200 μg · kg- 1 sur l’hemodynamie de 20 sujets lors de leurs revascularisations coronariennes. Nous mesurions ces effets pendant une période de due minutes sous anesthésie à l’étomidate et au piritramide, ce dernier étant ensuite remplacé par du sufentanil. Nous avons observé avec le pipécuronium et le pancuronium respectivement, des changements moyens de − 19 et de − 2 pour cent quant au débit cardiaque et de − 1 et +26 pour cent quant au pouls. Par la mesure de ses concentrations plasmatiques et urinaires, nous avons pu établir que le pipécuronium encours une redistribution initiate rapide (t1/2 = 7.6 min) suivie d’une elimination plus lente (t1/2 = 161 min) avec un volume de distribution central estimé à 102 ± 24 ml · kg- 1 et une clairance plasmatique de 1,8 ± 0,4 ml · kg- 1 · min- 1. En moins de 24 heures, on a retrouvé dans les urines, près de 56 pour cent du pipécuronium injecté dont le quart sous forme de son métabolite, le 3-désacétyl pipécuronium. Avec le type danesthésie employé, l’injection à bonne dose de pipécuronium n’a done pas entrainé d’effet hémodynamique néfaste. De plus, la cinétique d’un bolus de ce médicament s’est révélée semblable à celle observée en normothermie.
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Wierda, J.M.K.H., Karliczek, G.F., Vandenbrom, R.H.G. et al. Pharmacokinetics and cardiovascular dynamics of pipecuronium bromide during coronary artery surgery. Can J Anaesth 37, 183–191 (1990). https://doi.org/10.1007/BF03005467
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DOI: https://doi.org/10.1007/BF03005467