The Effect of Alcuronium and Tubocurarine on Blood Pressure and Heart Rate: A Clinical Comparison

Abstract

The effects of alcuronium (0.15 and 0.3 mg/kg) and tubocurarine (0.3 and 0.6 mg/kg) on arterial pressure and heart rate and rhythm have been compared in forty patients during nitrous oxide, oxygen and pethidine anaesthesia and in twenty patients during nitrous oxide, oxygen and halothane anaesthesia, prior to surgery. When halothane was used only the smaller doses of relaxants were given. Patients were divided into six homologous groups of ten patients. Both relaxants caused a fall in arterial pressure which was more pronounced during halothane anaesthesia. The fall in pressure was equal in degree after both relaxants but the period of maximum lowering was different, being 3-5 minutes after alcuronium and 10-15 minutes after tubocurarine. This difference might be explained by the tubocurarine-induced initial rise in blood pressure which was probably due to pain from venous irritation. Alcuronium had a slight tachycardic effect which was more pronounced during halothane anaesthesia. No e.c.g. changes were seen.

Cardiovascular Effects of Alcuronium in Man

“…Mean arterial pressure was little affected by alcuronium, a finding in keeping with the work of Tammisto and Welling (1969). Marked falls of blood pressure have been reported by other workers (Hunter, 1964;Baraka, 1967).…”

“…Stovner and Lund (1964) found that heart rate increased by up to 20 beats/min after administration of alcuronium (0.20-0.25 mg/kg); these measurements were made, however, at the time of endotracheal intubation, a procedure well known to cause tachycardia (Rollason and Hough, 1957). Tammisto and Welling (1969) found an increase of heart rate following administration of alcuronium in a dose of 0.15 mg/kg, and a greater effect with twice this dose.…”

“…This fall did not occur in the patients who were given alcuronium. This progressive bradycardia in the control patients may be attributed to tubocurarine, which causes an initial tachycardia followed by bradycardia (Tammisto and Welling, 1969). In the series II (suxamethonium plus phenoperidine) patients there was an increase of heart rate after the administration of alcuronium.…”

The Effect of Tubocurarine and Alcuronium on Suxamethonium-Induced Changes in Cardiac Rate and Rhythm

“…In addition, alcuronium seemed to give more complete protection against suxamethonium-induced bradycardia than tubocurarine. During anaesthesia a larger dose (0.15 mg/kg) of alcuronium has also been found to cause a moderate increase in heart rate (TAMMISTO & WELLING 1969). In the light of our present knowledge, it can only be supposed that alcuronium exerts a vagolytic effect similar to that of gallamine ( RIKER & WESCOE 195 1 ) .…”

Use of Alcuronium in Patients Undergoing Renal Transplantation

“…However, it does not appear to have been used in patients undergoing renal transplantation, or in patients with chronic renal failure. Specificity of action, minimal cardiovascular effects (Canak, 1965;Tammisto and Welling, 1969;Kennedy and Kelman, 1970) excellent relaxation and easy reversibility (Foldes et al, 1963) have prompted us to use the drug in patients with end-stage renal failure undergoing transplantation and its use forms the basis of this report.…”