Abstract
To compare haemodynamic responses associated with equipotent doses of muscle relaxants and high dose fentanyl (50 µg·kg−1), 40 non-hypertensive patients who were receiving beta adrenergic and calcium channel blocker therapy and undergoing coronary bypass surgery were randomized to four study groups receiving the following: (1) atracurium: 0.4 mg·kg−1, (2) pancuronium: 0.12 mg·kg−1, (3) vecuronium: 0.12 mg·kg−1, or (4) pancuronium–metocurine mixture: (0.4 mg + 1.6 mg·ml−1):1 ml/10kg. Neuromuscular blockers were injected with fentanyl at induction. Haemodynamics were recorded with the patients awake (baseline), at two minutes post-induction, and at two and five minutes after intubation.
Pancuronium was the only drug associated with significant increases in HR; no other significant changes occurred within each group when compared to their respective baseline haemodynamics. HR increased more after induction with pancuronium when compared to atracurium (23 vs. 4 per cent. p < 0.05) and to vecuronium (23 vs. 2 per cent, p < 0.05), and when compared to vecuronium after intubation (29 vs. 7 per cent, p < 0.05). The pancuronium–metocurine mixture caused tachycardia which was less than, though not significantly different than with pancuronium; however, HR returned to baseline by five minutes with the mixture, but remained elevated with pancuronium (3 vs. 18 per cent, p < 0.05). SVR fell more on induction with atracurium when compared to vecuronium (–18 vs. 1 per cent, p < 0.05). These changes in HR or SVR were not accompanied by ECG signs of ischaemia. Vecuronium was associated with the most stable overall haemodynamic course at all measurement times. In general, intubating doses of the neuromuscular blockers studied appeared safe for use in patients with coronary artery disease.
Résumé
Afin de comparer les réponses hémodynamiques suite à l’administration de doses équipotentes de relaxants musculaires et de hautes doses de fentanyl (50 µg·kg−1), 40 patients normotendus sur beta-bloqueurs et bloqueurs de canaux calciques devant subir un pontage aorto-coronarien ont été randomisés en quatre groupes d’étude recevant les doses suivantes: 1) atracurium : 04mg·kg−1 2) pancuronium: 0.12mg·kg−1, 3) vecuronium: 0.12 mg·kg−1, ou 4) pancuronium-metocurine (0.4 mg + 1.6 mg·kg−1) : 1 mil1 10 kg. Les bloqueurs neuromusculaires ont été injectés avec le fentanyl lors de I’induction. La réponse hémodynamiques a été enregistrée quand les patients étaient conscients (contrôle), deux minutes après l’ induction, et à deux et cinq minutes après l’intubation.
Le pancuronium a été le seul médicament associé à une augmentation significative de la frequence cardiaque; aucun autre changement significatif n’est survenu pour aucun des groupes lorsque comparé à leurs données hémodynamiques de base respectivement. La fréquence cardiaque augmenta plus après induction au pancuronium comparativement à l’atracurium (23 vs 4 pour cent, p < 0.05), et au vecuronium (23 vs. 2 pour cent, p < 0.05), et comparativement au vécuronium après intubation (29 vs. 7 pour cent, p < 0.05). Le mélange pancuronium-métocurine provoqua une tachycardie qui était moindre mais non significativement différente lorsque comparé au pancuronium; cependant la fréquence cardiaque est retournée aux valeurs de contrôle en dedans de cinq minutes avec le mélange alors qu’elle resta élevée avec le pancuronium (3 vs. 18 pour cent, p < 0.05). La réistance vasculaire systémique diminua plus lors de l’induction avec l’atracurium comparativement au vecuronium (-18 vs. 1 pour cent p < 0.05). Ces changements dans la fréquence cardiaque ou la résistance vasculaire systémique n’était pas accompagnée de signe électrocardiographiques d’ischémie. Le vécuronium a permis une meilleure stabilité hémodynamique à tous les temps de mesure. En général, les doses d’intubation des relaxants musculaire étudiées apparaissent sécures lors de l’utilisation chez les patients avec maladie coronarienne artériosclérotique.
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Sethna, D.H., Starr, N.J. & Estafanous, F.G. Cardiovascular effects of non-depolarizing neuro-muscular blockers in patients with coronary artery disease. Can Anaesth Soc J 33, 280–286 (1986). https://doi.org/10.1007/BF03010738
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DOI: https://doi.org/10.1007/BF03010738