Comparison of Rocuronium and Vecuronium in Patients Undergoing Elective Ultrafast-Track Off-Pump Coronary Artery Bypass Surgery

Abstract

Background Neuromuscular blocking drugs are necessary in cardiac surgery to facilitate smooth intubation and ventilation conditions, avoid patient movement, reduce oxygen consumption, and prevent shivering. Hemodynamic stability is very essential in cardiac surgery because the coronary reserve is below normal in such patients. Aims This study was conducted with the objective of comparing rocuronium, the “near-ideal” muscle relaxant with vecuronium, an already established neuromuscular blocking agent in patients undergoing elective ultrafast-track off-pump coronary artery bypass surgery (CABG). Settings and Design This prospective, randomized comparative study included 60 patients scheduled for elective off-pump CABG procedures under general anesthesia in the period between May 2015 and March 2016. Materials and Methods Patients were randomized in equal numbers to either the rocuronium group or the vecuronium group, and intubating conditions and various hemodynamic parameters were observed at different time points. Statistical Analysis Used Categorical variables were evaluated using the chi-square test, whereas the Student t-test or Mann–Whitney test were used for continuous variables. Results Pulse rate in the rocuronium group was lesser (79.97 ± 7.42) (p < 0.05) at the time of intubation as compared with the vecuronium group (92.33 ± 8.93). Systolic blood pressure was higher in the vecuronium group (150.70 ± 14.05) at the time of intubation as compared with the rocuronium group (130.27 ± 9.95) (p < 0.05). Intubating conditions, mean arterial pressure, and diastolic blood pressure changes were similar in both groups. Conclusions Rocuronium provides good-to-excellent intubating conditions and is devoid of any significant cardiovascular changes causing hemodynamic instability when compared with vecuronium in patients undergoing elective ultrafast-track off-pump CABG.

Comparison of Hemodynamic Changes in Patients Undergoing Laparoscopic Cholecystectomy using rocuronium and vecuronium for Intubation and Maintenance under General Anesthesia

“…The hemodynamic changes during intubation were comparable in a study by Mohamed and Sameh[ 12 ] study where vecuronium and rocuronium were used for rapid sequence induction in morbidly obese patients in a randomized study. Shah and Kulshrestha[ 13 ] also shown that in patients undergoing elective ultrafast-track off-pump coronary artery bypass graft, rocuronium provides good-to-excellent intubating conditions without any significant hemodynamic instability when compared with vecuronium which corroborated with our findings.…”

Propensity of use of neuromuscular blocking agents among Indian anaesthesiologists: A questionnaire-based survey

“…Hence, any agent that stimulates the cardiovascular system and increases the myocardial oxygen demand should be avoided. 11 Vecuronium and rocuronium decrease the heart rate and are useful NMBs in patients with high baseline heart rate. 12 A recent study showed that vecuronium had better and more cardiac favourable variables and more cardiovascular stability than rocuronium and atracurium.…”

Fast Tracking in Off Pump CABG with Supraglottic Airway and TIVA

“…The anesthetic approaches that have been developed and utilized over period of time for patients undergoing OPCAB are general anesthesia (GA) with opioids and inhalation anesthesia; GA combined with controlled ventilation and HTEA; GA combined with intrathecal opioids; awake regional anesthesia with spontaneous ventilation using HTEA alone; total intravenous anesthesia (TIVA) with ETT; and TIVA with laryngeal mask airway (LMA). [3][4][5][6][7] Scientific evidence and practical experience make TIVA the recommended choice for cardiac surgery (►Fig. 1).…”