Abstract
Purpose
To measure the haemodynamic effects of rocuronium in adults undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Methods
Twenty patients undergoing elective cardiac surgical procedures with moderate hypothermic nonpulsatile bypass participated in this prospective, observational study. After anaesthetic induction, recovery from succinylcholine, and achievement of baseline haemodynamic stability, patients received 0.6 mg·kg−1 rocuronium as an initial rapid intravenous bolus. Maintenance dosing of 0.2 mg·kg−1 was continued for the remainder of the procedure, Haemodynamic measurements (heart rate, systemic arterial systolic, diastolic, and mean arterial pressure, pulmonary arterial systolic, diastolic, and mean pressure, pulmonary capillary wedge pressure, central venous pressure, and thermodilution cardiac output measurements) were obtained for the first five minutes after rocuronium administration, and subjects were observed for histamine-related symptoms.
Results
Central venous pressure decreased from baseline at two and five minutes after the rocuronium bolus, and mean pulmonary artery pressure decreased at five minutes. No changes were observed in heart rate, mean systemic arterial pressure, pulmonary capillary wedge pressure, cardiac index, stroke volume, systemic vascular resistance, or pulmonary vascular resistance, nor did any patient manifest any other histamine-related symptoms.
Conclusion
The haemodynamic profile for a 0,6 mg·kg−1 bolus of rocuronium is acceptable for patients with cardiovascular disease.
Résumé
Objectif
Mesurer les effets hémodynamiques du rocuronium chez des adultes subissant une chirurgie cardiaque sous CEC.
Méthodes
Vingt patients subissant une chirurgie cardiaque sous CEC à flot non pulsatile et sous hypothermie modérée ont participé à cette étude d’observation prospective. Après l’induction de l’anesthésie, récupération de l’effet de la succinylcholine et obtention d’une stabilité hémodynamique de base, les patients ont reçu par voie IV rapide un bolus initial de 0,6 mg·kg−1 de rocuronium suivi de doses de maintien de 0,2 mg·kg−1 durant toute la durée de la procédure. Durant les premières cinq minutes après l’administration de rocuronium, les mesures hémodynamiques suivantes ont été obtenues : rythme cardiaque, pression artérielle systémique et pulmonaire, systolique, diastolique et moyenne, pression capillaire bloquée, pression veineuse centrale et mesures du débit cardiaque par thermodilution. On a aussi recherché chez les patients de symptômes liés à la libération d’histamine.
Résultats
Après un bolus de rocuronium, on a observé une diminution de la pression veineuse centrale après deux et cinq minutes. Les autres variables, rythme cardiaque, pression artérielle moyenne, pression capillaire bloquée, index cardiaque, volume d’éjection, résistance vasculaire pulmonaire et systémique, n’ont présenté aucun changement. Aucun patient n’a démontré de symptômes liés à la libération d’histamine.
Conclusion
Une dose bolus de 0,6 mg·kg−1 de rocuronium possède un profil hémodynamique acceptable pour des patients présentant maladie cardiovasculaire.
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This work was supported by a grant (to TXF) from Organon Inc.
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Hudson, M.E., Rothfield, K.P., Tullock, W.C. et al. Haemodynamic effects of rocuronium bromide in adult cardiac surgical patients. Can J Anaesth 45, 139–143 (1998). https://doi.org/10.1007/BF03013252
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DOI: https://doi.org/10.1007/BF03013252