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Canadian Journal of Anesthesia, Vol 33, 280-286, Copyright © 1986 by Canadian Anesthesiologists' Society

Cardiovascular Effects of non-depolarizing Neuromuscular Blockers in Patients with Coronary Artery Disease

DHUN H. SETHNA MD1, NORMAN J. STARR MD1, and FAWZY G. ESTAFANOUS MD1

1 The Cleveland Clinic Foundation, Department of Cardiothoracic Anesthesia, Cleveland, Ohio

Address correspondence to: Dr. Dhun H. Sethna, Department of Cardiothoracic Anesthesia, 9500 Euclid Avenue, Cleveland, Ohio 44106.

To compare haemodynamic responses associated with equipotent doses of muscle relaxants and high dosefentanyl (50 µg·-1), 40 non-hypertensive patients who were receiving beta adrenergic and calcium channel blocker therapy and undergoing coronary bypass surgery were randomized to four study groups receiving the following: (1) atracurium: 0.4 mg·kg-1, (2) pancuronium: 0.12 mg·kg-1, (3) vecuronium: 0.12 mg·kg-1, or (4) pancuronium-metocurine mixture: (0.4 mg + 1.6 mg·ml-1): ml/10 kg. Neuromuscular blockers were injected with fentanyl at induction. Haemodynamics were recorded with the patients awake (baseline), at two minutes post-induction, and at two and five minutes after intubation.

Pancuronium was the only drug associated with significant increases in HR; no other significant changes occurred within each group when compared to their respective baseline haemodynamics. HR increased more after induction with pancuronium when compared to atracurium (23 vs. 4 per cent, p < 0.05) and to vecuronium (23 vs. 2 per cent, p < 0.05), and when compared to vecuronium after intubation (29 vs. 7 percent, p < 0.05). The pancuronium-metocurine mixture caused tachycardia which was less than, though not significantly different than with pancuronium; however, HR returned to baseline by five minutes with the mixture, but remained elevated with pancuronium (3 vs. 18 per cent, p < 0.05). SVR fell more on induction with atracurium when compared to vecuronium (-18 vs. 1 per cent, p < 0.05). These changes in HR or SVR were not accompanied by ECG signs of ischaemia. Vecuronium was associated with the most stable overall haemodynamic course at all measurement times. In general, intubating doses of the neuromuscular blockers studied appeared safe for use in patients with coronary artery disease.

Key Words: NEUROMUSCULAR RELAXANTS: pancuronium, vecuronium, atracurium, metocurine • ANAESTHETICS INTRAVENOUS: fentanyl • ANAESTHESIA: cardiovascular






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Copyright © 1986 by the Canadian Anesthesiologists' Society.