Contribution of muscle relaxant to the haemodynamic course of high-dose fentanyl anaesthesia: a comparison of pan-curonium, vecuronium and atracurium

Pharmacokinetics and cardiovascular dynamics of pipecuronium bromide during coronary artery surgery

“…It has been clearly demonstrated by Karliczek et al ts that general anaesthesia ia a powerful modulator of the autonomic balance. Heinonen et al 24 have shown a higher incidence of haemodynamic effects when pancuronium was supplemented by high-dose fentanyl anaesthesia, than in this study. These observations support the contention that the frequency and severity of the haemodynamic effects of neuromuscular blocking agents may be modulated by the technique and the depth of anaesthesia.…”

Cardiovascular effects of vecuronium, atracurium, pancuronium, metocurine and RGH‐420 1 in dogs

“…This affects the haemodynamic status by means of ganglionic blockade, vagolysis or by a sympathomimetic action. Cardiovascular effects of neuromuscular blocking drugs as reported in the literature are frequently assessed under non-standardised clinical conditions (1)(2)(3)(4)(5) or obscured by circulatory effects, produced by a volatile anaesthetic (16) or concomitant cardiac medication (1-3). We have investigated the cardiovascular effects of five competitive muscle relaxants under standardised conditions in a dog model, using a balanced anaesthesia technique.…”

“…The contribution of neuromuscular blocking drugs to the circulatory effects of anaesthesia is well established, especially with respect to certain poor-risk patient groups (1)(2)(3). Recent reports have questioned the usefulness of pancuronium and vecuronium because of undesirable positive (4) or negative chronotropic effects (5)(6)(7).…”

Haemodynamic effects of high‐dose vecuronium compared with pancuronium in beta‐blocked patients with coronary artery disease during fentanyl‐diazepam‐nitrous oxide anaesthesia

“…The vagolytic (18) and sympaticomimetic effects (19) of pancuronium are well known. Pancuronium may thus counteract untoward circulatory effects of an opioid, preventing a narcotic-induced bradycardia from becoming manifest (20,21). In fact, the tachycardic effect of pancuronium may override the bradycardic effect from even high doses of fentanyl and, thereby, cause myocardial ischaemic episodes, as shown by Thomson & Putnins (2).…”