Abstract
To define the role of muscle relaxants in haemodynamic responses to high-dose (75 µg·kg-1) fentanyl anaesthesia and to noxius stimuli associated with intubation and sternal spread during coronary artery bypass surgery, we compared haemodynamics between three groups of patients given either pancuronium (0.1 mg·kg-1, n = 11), vecuronium (0.086 mg·kg-1, n = 11) or atracurium (0.43 mg·kg-1, n = 12). Additional doses of the relaxants were given to maintain a 90 per cent neuromuscular block. Patients given pancuronium showed no increases in mean values of heart rate, arterial pressure or cardiac output during the induction of anaesthesia or after intubation, whereas a decrease in these variables was observed in the vecuronium group. The haemodynamics in the atracurium group were intermediate compared with the other two study groups. In spite of a decrease in coronary perfusion pressure, no patient given vecuronium developed myo cordial ischaemia. An advantage of vecuronium over pancuronium and atracurium was an attenuation of the blood pressure response to sternotomy. Patients given atracurium had a small increase in pulmonary vascular resistance during sternotomy. Our patients continued their beta-adrenergic antagonist medication until the morning of the day of operation and they were pretreated with a small intravenous dose ofdiazepam (0.1 mg·kg1) before induction of anaesthesia. These drugs may have prevented the deleterious haemodynamic effects observed by some investigators after the administration of pancuronium during high-dose fentanyl anaesthesia.
Résumé
Afin de définir le rôle des relaxants musculaires dans les réponses hémodynamiques aux hautes doses (75;g·kg-1) defentanyl et à la stimulation associée à l’intubation et l’écartement sternal durant la chirurgie pour pontage aortocoronarien, on a comparé l’hémodynamie entre trois groupes de patients ayant reçu soit du pancuronium (0.1 mg·kg-1,n = 11), soit du vecuronium (0.086 mg·kg-1, n = 11), soit l’atracurium (0.43 mg·kg-1), n = 12). Des doses additionnelles de relaxants musculaires ont été données afin de maintenir le bloc neuromusculaire à 90 pour cent. Les patients ayant reçu du pancuronium n’ont pas démontré une augmentation dans les valeurs moyennes de la fréquence cardiaque, la pression artérielle ou le débit cardiaque lors de l’induction de l’anesthésie et après intubation. Ces variables cependant ont diminué chez le groupe ayant reçu du vecuronium. Pour le groupe atracurium, les valeurs hémodynamiques ont été intermédiates comparativement aux deux autres groupes étudiés. Malgré une diminution de la pression de perfusion coronarienne, aucun patient ayant reçu du vecuronium n’a développé de l’ischémie myocardique. Comparativement au pancuronium et l’atracurium, l’avantage du vecuronium était représenté par une atténuation de la tension artérielle en réponse à la sternotomie. Les patients ayant reçu de l’atracurium ont présenté une augmentation minime de la résistance vasculaire pulmonaire lors de la sternotomie. Nos patients ont continué leur médication habituelle aux antagonistes bêta-adrénergiques jusqu’au matin de l’opération et ont reçu une petite dose intraveineuse de diazepam (0.1 mg·kg-1) avant l’induction de l’anesthésie. Ces médicaments peuvent avoir prévenu les effets hémodynamiques néfastes observés par d’autres investigateurs apres l’administration du pancuronium lors de l’anesthésie au fentanyl à haute dose.
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Heinonen, J., Salmenpera, M. & Suomivuori, M. Contribution of muscle relaxant to the haemodynamic course of high-dose fentanyl anaesthesia: a comparison of pan-curonium, vecuronium and atracurium. Can Anaesth Soc J 33, 597–605 (1986). https://doi.org/10.1007/BF03014267
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DOI: https://doi.org/10.1007/BF03014267