A comparison of pipecuronium with pancuronium on haemodynamic variables and plasma catecholamines in coronary artery bypass patients

Neidhart, P.; Champion, P; Vogel, John H.K.; Zsigmond, Elemér K.; Tassonyi, E.

doi:10.1007/bf03011539

Cited by 8 publications

(4 citation statements)

References 23 publications

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“…If noxious stimuli cause increased sympathetic and parasympathetic output, whether these changes are manifested as pressor, depressor, or both will likely depend on the baseline physiology of the animal. Different combinations of anesthetics and neuromuscular blocking agents may favor either pressor or depressor responses; previous studies showed that different anesthetics selectively block pressor responses (Farber et al 1995;Ness and Gebhart 1988;Samso et al 1994), that steroidal and nonsteroidal anticholinergic neuromuscular blocking agents induce different levels of tachycardia and increased BP by altering vagal tone in different ways (Appadu and Lambert 1994;Hunter 1995;Neidhart et al 1994;Rathmell et al 1993;Shorten et al 1995), and that animals of different sources can display differences in cardiovascular responses to sensory stimuli (Abdeen et al 1995;Meller et al 1992;Taylor et al 1995).…”

Section: Discussionmentioning

confidence: 99%

“…In preliminary experiments, the anticholinergic neuromuscular blocking agents gallamine triethiodide (4 mg/kg) and pancuronium (1 mg/kg) were used but found to induce severe tachycardia under urethan anesthesia. Vecuronium (4 mg/kg) and pipecuronium (1 mg/ kg) were tested because they are steroidal neuromuscular blocking agents that are unlikely to cause tachycardia (Neidhart et al 1994;Rathmell et al 1993;Shorten et al 1995), but were found ineffective as recovery occurred within Ͻ20 min. To increase the duration of muscular paralysis without inducing tachycardia, we therefore used a mixture of pipecuronium and doxacurium.…”

Section: Physiological Managementmentioning

confidence: 99%

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Cardiovascular and Neuronal Responses to Head Stimulation Reflect Central Sensitization and Cutaneous Allodynia in a Rat Model of Migraine

Yamamura

Malick

Chamberlin

et al. 1999

Journal of Neurophysiology

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Reduction of the threshold of cardiovascular and neuronal responses to facial and intracranial stimulation reflects central sensitization and cutaneous allodynia in a rat model of migraine. Current theories propose that migraine pain is caused by chemical activation of meningeal perivascular fibers. We previously found that chemical irritation of the dura causes trigeminovascular fibers innervating the dura and central trigeminal neurons receiving convergent input from the dura and skin to respond to low-intensity mechanical and thermal stimuli that previously induced minimal or no responses. One conclusion of these studies was that when low- and high-intensity stimuli induce responses of similar magnitude in nociceptive neurons, low-intensity stimuli must be as painful as the high-intensity stimuli. The present study investigates in anesthetized rats the significance of the changes in the responses of central trigeminal neurons (i.e., in nucleus caudalis) by correlating them with the occurrence and type of the simultaneously recorded cardiovascular responses. Before chemical stimulation of the dura, simultaneous increases in neuronal firing rates and blood pressure were induced by dural indentation with forces >/= 2.35 g and by noxious cutaneous stimuli such as pinching the skin and warming > 46 degrees C. After chemical stimulation, similar neuronal responses and blood pressure increases were evoked by much smaller forces for dural indentation and by innocuous cutaneous stimuli such as brushing the skin and warming it to >/= 43 degrees C. The onsets of neuronal responses preceded the onsets of depressor responses by 1.7 s and pressor responses by 4.0 s. The duration of neuronal responses was 15 s, whereas the duration of depressor responses was shorter (5.8 s) and pressor responses longer (22.7 s) than the neuronal responses. We conclude that the facilitated cardiovascular and central trigeminal neuronal responses to innocuous stimulation of the skin indicate that when dural stimulation induces central sensitization, innocuous stimuli are as nociceptive as noxious stimuli had been before dural stimulation and that a similar process might occur during the development of cutaneous allodynia during migraine.

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Section: Discussionmentioning

confidence: 99%

Section: Physiological Managementmentioning

confidence: 99%

Cardiovascular and Neuronal Responses to Head Stimulation Reflect Central Sensitization and Cutaneous Allodynia in a Rat Model of Migraine

Yamamura

Malick

Chamberlin

et al. 1999

Journal of Neurophysiology

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“…Plasma adrenaline and noradrenaline concentrations increase when pancuronium is administered to facil‐ itate tracheal intubation [16] or after administration of pancuronium to ill neonates [17]. In patients anaesthetized with midazolam (0.1 mg kg −1 ) and fentanyl (15 μg kg −1 ), plasma noradrenaline concentration decreased significantly less in patients who received pancuronium than in those who received an equi‐ potent dose of pipecuronium [18]. In the current study, no significant change in plasma catecholamine concentrations occurred following either rocuronium or vecuronium administration.…”

Section: Introductionmentioning

confidence: 99%

Changes in plasma catecholamine concentrations and haemodynamic effects of rocuronium and vecuronium in elderly patients

Shorten¹,

Uppington²,

Comunale³

1998

Eur J Anaesthesiol

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Rocuronium administration may cause tachycardia and an increase in cardiac index. Pancuronium, another steroidal non-depolarizing muscle relaxant, augments release of, and blocks re-uptake of catecholamines at adrenergic nerve endings. This study compared the haemodynamic effects of, and changes in catecholamine concentrations following administration of vecuronium (0.12 mg kg-1) or rocuronium (0.9 mg kg-1) to elderly patients. Thirty patients, 65 years or older, not receiving beta-blockers, were studied. During thiopentone, fentanyl, nitrous oxide anaesthesia, either rocuronium (0.9 mg kg-1) or vecuronium (0.12 mg kg-1) was administered, according to random allocation. In all 30 patients, blood pressure and heart rate were measured before induction of anaesthesia, immediately and 1 min after induction, 1 and 2 min after muscle relaxant administration, and immediately, 1 and 2 min after tracheal intubation. In the latter 20 patients, samples for plasma catecholamine estimation were obtained prior to, and 1 min after muscle relaxant administration and 1 min after tracheal intubation. Blood pressure and heart rate were similar in the two groups throughout the study. Plasma noradrenaline concentrations were similar in the vecuronium and rocuronium groups prior to muscle relaxant administration (589(SD240) and 444(SD213) pg mL-1, respectively), 1 min after muscle relaxant administration (602(SD220) and 520(SD392) pg mL-1, respectively) and 1 min after tracheal intubation (597(SD351) and 440(SD181) pg mL, respectively). There was no significant change in either plasma noradrenaline or adrenaline concentrations in either group following muscle relaxant administration or tracheal intubation. The use of rocuronium (0.9 mg kg-1) in elderly patients does not result in a clinically significant change in heart rate, blood pressure or plasma catecholamine concentration.

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“…[510] Premedication and induction drugs may attenuate the circulatory response,[9] many drugs and techniques have been tried in an effort to attenuate adverse hemodynamic responses to laryngoscopy and endotracheal intubation. [13141516] A patient's medical condition affects his physiologic response. Such hemodynamic changes can result in myocardial ischemia, but seem to cause little harm to most patients.…”

Section: Discussionmentioning

confidence: 99%

Is I-gel airway a better option to endotracheal tube airway for sevoflurane-fentanyl anesthesia during cardiac surgery?

Elgebaly

Eldabaa

2014

Anesth Essays Res

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Background:Anesthetists used lower doses of fentanyl, successfully with hemodynamic control by titrating volatile anesthetic agents or vasodilators for fast-tracking in cardiac surgery.Hypothesis:Lower total doses of anesthetics and fentanyl could be required with hemodynamic control by use of supraglottic devices than endotracheal tube (ETT) and helps in fast-tracking.Design:A prospective randomized observational clinical trial study.Aims:The authors compared the utility of I-gel airway with a conventional ETT during the induction and maintenance of anesthesia with sevoflurane and fentanyl in adults undergoing cardiac surgery.Patients and Methods:A total of 49 adult patients underwent cardiac surgery were randomized into two groups according to the airway management: I-gel group (n = 23) and ETT group (n = 26). Doses of fentanyl and hemodynamic parameters (heart rate [HR], mean arterial pressure [MAP] central venous pressure [CVP], pulmonary artery pressure [PAP], and pulmonary capillary wedge pressure [PCWP]) were recorded preoperative, 5 min following tracheal intubation or I-gel airway insertion, after skin incision, after stenotomy, and after weaning off bypass.Results:None of the patients in the I-gel group required additional doses of fentanyl during the I-gel insertion, compared with 74% of the patients during laryngoscopy and endotracheal insertion in the ETT group, for an average total dose of 22.6 ± 0.6 μg/kg. The MAP and HR did not significantly differ from the baseline values at any point of measurement in either group. Furthermore, CVP, PAP, and PCWP measured during the procedure were significantly lower in I-gel group than ETT group. Extubation required more amount of time in ETT than I- gel group.Conclusion:The I-gel airway is well-tolerated by adult patients undergoing cardiac surgery, and requires lower total doses of anesthetics than endotracheal intubation with hemodynamic control and helps in fast-tracking.

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A comparison of pipecuronium with pancuronium on haemodynamic variables and plasma catecholamines in coronary artery bypass patients

Cited by 8 publications

References 23 publications

Cardiovascular and Neuronal Responses to Head Stimulation Reflect Central Sensitization and Cutaneous Allodynia in a Rat Model of Migraine

Cardiovascular and Neuronal Responses to Head Stimulation Reflect Central Sensitization and Cutaneous Allodynia in a Rat Model of Migraine

Changes in plasma catecholamine concentrations and haemodynamic effects of rocuronium and vecuronium in elderly patients

Is I-gel airway a better option to endotracheal tube airway for sevoflurane-fentanyl anesthesia during cardiac surgery?

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