Cardiovascular effects of an intubating dose of rocuronium 0.6 mg kg-1 in anaesthetized patients, paralysed with vecuronium

Abstract

We have studied, in adult patients, ASA I-II, the cardiovascular effects of an intubating dose of rocuronium 0.6 mg kg-1. After induction, patients were paralysed with vecuronium and the trachea intubated. Heart rate (HR) and non-invasive mean arterial pressure (MAP) were measured every 1 min. After stabilization of HR and MAP, defined as < 3% change over three measurements, rocuronium (n = 20) or saline (n = 10) was injected at random. Mean HR increased initially from 66.6 to 72.1 beat min-1, 4 min after rocuronium, and then decreased gradually to 69.6 beat min-1, that is a net increase of 3.3 beat min-1 over 10 min (P < 0.001), whereas after saline there was a gradual decrease from 65.8 to 60.9 beat min-1 (P < 0.001) over 10 min. From the third minute, HR was significantly higher in the rocuronium group. Mean MAP decreased in both groups within 10 min to a similar extent after rocuronium and saline, that is from 74.9 to 72.1 mm Hg and from 74.7 to 72.2 mm Hg, respectively (both P < 0.001). There were no differences in MAP at any time between the rocuronium and saline groups. We conclude that an intubating dose of rocuronium, in the absence of haemodynamic effects related to paralysis itself, resulted in a limited increase in HR without change in MAP, probably because of its weak vagolytic activity.

Cardioventilatory coupling: effects of IPPV

“…This difference is well described 19 and most likely represents a combined pressure reversal effect of IPPV, vagal withdrawal secondary to reduced venous return and an alteration in brain stem ventilatory rhythmogenesis; also, a small vagolytic contribution from rocuronium cannot be excluded. 20 The reverse RSA (inspiratory heart rate deceleration) seen in three subjects undergoing mechanical ventilation has been noted previously by Yli-Hankala and colleagues. 21 In summary, cardioventilatory coupling could not be demonstrated during intermittent positive pressure ventilation in anaesthetized subjects.…”

Intraoperative hemodynamics with vecuronium bromide and rocuronium for maintenance under general anesthesia

“…Cardiovascular effects of an intubating dose of rocuronium was studied by Wierda et al ., in 1997 and concluded that rocuronium caused a mild increase in heart rate without a change in MAP. [ 20 ]…”

Anesthetic Implications in Rubinstein-Taybi Syndrome

“…When neuromuscular is required, nondepolarizing agents are suggested. Given the potential proarrhythmogenic effects of medications with vagolytic effects, there may be a theoretical advantage to the use of cis-atracurium over rocuronium for non-emergent airway management [21]. Alternatively, endotracheal intubation can be accomplished without neuromuscular blockade as noted in our pa-tient with the combination of sevoflurane and propofol.…”