Haemodynamic Effects of Vecuronium, Pancuronium and Atracurium in Patients With Coronary Artery Disease

Abstract

Thirty patients with ischaemic heart disease scheduled for coronary artery bypass grafting were randomly allocated to three equal groups. Following morphine, hyoscine and pentobarbitone premedication, anaesthesia was induced with diazepam 0.3 mg kg-1. Five minutes later neuromuscular blockade was induced with pancuronium 0.1 mg kg-1, vecuronium 0.1 mg-1 or atracurium 0.5 mg kg-1, followed after 6 min by fentanyl 25 micrograms kg-1. Pancuronium and atracurium caused significant increases in heart rate, while vecuronium induced little change. Systemic vascular resistance decreased significantly from 1515 dyn s cm-5 to 1200 dyn s cm-5 following atracurium. Cardiac index was increased transiently in the atracurium group, but a more sustained increase was observed following pancuronium. Nine patients in the atracurium group showed skin flushing and one developed skin weals.

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).…”

Cisatracurium bei Koronarbypassoperationen - ein Vergleich mit Pancuronium

“…Ziel unserer Arbeit war es, die kumulativen Wirkungen einer Anästhetikakombination zu untersuchen, die in der kli-nischen Situation bei der Einleitung herzchirurgischer Patienten zum Tragen kommen. Untersuchungen, die die Effekte von Pancuronium in einem steady state untersuchten, fanden einen signifikanten Anstieg der Herzfrequenz nach einer Dosis, wie sie zur Muskelrelaxation eingesetzt wird [5,7,11,15,20,21]. Sie fanden eine stabile Herzfrequenz in der Pancuroniumgruppe im Gegensatz zu den Atracurium-und Metocuringruppen, in denen die HF abfiel bei unverändertem CO, wie wir es in unserem Cisatracuriumkollektiv beobachteten.…”

The Role of Histamine in the Cardiovascular Effects of Atracurium

“…Changes induced by atracurium in the cardiovascular system have been documented by many investigators [1][2][3][4]. The aim of the present study was to examine these effects in detail, to see if histamine is primarily responsible for such effects.…”