Haemodynamic effects of rocuronium during fentanyl anaesthesia: comparison with vecuronium
Eamon P. McCoy FFARCSI
0
Venkat R. Maddineni mo FFARCSI
0
Peter Elliott MDFRCAnaes
0
Rajinder K. Mirakhur MDPhDFRCAnaes
0
Ian W. Carson MDFFARCSI
0
Ronald A. Cooper mt~ FFARCSI
0
0
From the Departments of Anaesthesia, The Queen's University and the Royal Victoria Hospital
,
Belfast,Northern Ireland
. of Anaesthetics,
The Queen's Universityof Belfast,Whitla Medical Building
, 97 Lisburn Road,
Belfast
,BT9 7BL,
Northern Ireland (UK
). Acceptedfor publication 16th April
, 1993
Haemodynamic variables were measured following administration o f rocuronium 0.6 mg "kg -I or vecuronium 0.08 mg" kg - I (approximately equivalent to 2 )< ED95 doses) in patients anaesthetized withfentany150 I~g" kg -1 and scheduled to undergo elective coronary artery bypass grafting. There were increases in stroke volume index (+15%) and cardiac index (+11%), and a decrease in pulmonary capillary wedge pressure (-25%) following administration o f rocuronium (P < 0.05). The changes in heart rate (+7%), mean arterial pressure (-5%), systemic vascular resistance (-12%) and other measured or derived indices were insignificant. In comparison the administration o f vecuronium was associated with decreases in heart rate (-7%), mean pulmonary artery pressure (-17%), central venous pressure ( - 1 5 % ) a n d the rate-pressure product ( - 9 % ) (P < 0.05). The changes in mean arterial pressure (-7%), cardiac index ( - 6 % ) and systemic vascular resistance (-8%) following vecuronium were insignificant. There were no differences in any o f the variables between rocuronium and vecuronium. The absolute values o f all variables were, however, within acceptable clinical limits. There was no evidence o f histamine release in any patient. The present study shows that rocuronium 0.6 mg" kg -I is associated with changes o f only small magnitude in haemodynamic variables.
-
Haemodynamic effects
of rocuronium during
fentanyl anaesthesia:
comparison with
o
vecuronlum
Les variables h~modynamiques ont ~t~ mesur~es aprbs
l'administration de rocuronium 0,6 rag" kg - t ou de v~curonium
0,8 mg" kg -~ (doses approximativement ~gales ~ 2 X ED95)
chez des patients anesthksi~s avec du fentanyl 50 I~g" kg - t et
programm~s pour subir une chirurgie de pontage
aortocoronarien en routine. Il y a une augmentation du volume dgjection
index~ (+15%)et d~ndex cardiaque (+11%)et une diminution
de la pression capillaire pulmonaire bloqu~e (-25%) apr~s
Fadministration de rocuronium (P < 0,05). Les modifications de
fr~quence cardiaque (+7%), de pression art&idle moyenne
(-5%), de r~sistance vasculaire syst~mique (-12~ et des autres
parambtres mesur~s ou d~rivds sont insignifiantes. Par
comparaison, l'administration de v~curonium est associ~e avec une
diminution de la fr~quence cardiaque (-7%), de la pression
d'artkre pulmonaire moyenne (-17%), de la pression veineuse
centrale ( - 15%) et.du produit fr~quence cardiaque-pression
art&ielle ( - 9 % ) (P < 0,05). Les modifications en pression
art~rielle moyenne (-7%), en index cardiaque ( - 6 % ) et en
r~sistance vasculaire syst~mique ( - 8 % ) apr~s le v~curonium sont
insignificates. I1 n'y a aucune difference de variables entre le
rocuronium et le v~curonium. Les valeurs absolues de toutes
les variables se situent dans les limites cliniques acceptables.
Des manifestations de lib&ation d'histamine ne se sont
pr~sent~es chez aucun patient. Cette ~tude montre que le
rocuronium 0,6 rag" kg - j n'est associ~ qu~ de faibles
modifications des variables h~modynamiques.
Cardiovascular stability is considered desirable in an ideal
muscle relaxant. The introduction of vecuronium
bromide and atracurium dibesylate considerably improved
the flexibility in the clinical administration of muscle
relaxants. The intermediate duration of action of these
compounds is more suitable to the duration of action of the
majority of routine surgery than that of any other
clinically used nondepolarizing muscle relaxants. While in
general both these agents provide cardiovascular stability,
there have been reports of bradycardia with vecuronium
and of histamine liberation with atmcurium. 1-5 In
addition both have a relatively slow onset of action. 6
PipeTABLE I Patient characteristics (mean 5- SD)
curonium and doxacurium which have been recently
introduced, provide very good cardiovascular stability but
are quite slow and long-acting. 6
Rocuronium is a new aminosteroidal competitive
muscle relaxant which, in animal studies, has been shown
to have a more rapid onset of action and minimal
cardiovascular and vagal side effects in doses of up to 3-4
X ED95.7,8 Studies in humans have also confirmed the
onset of action to be rapid with a duration of action
resembling that of vecuronium.9,1~
The detailed haemodynamic effects of the drug have
not yet been reported although routine observations
during early neuromuscular studies have not shown
important cardiovascular side effects. ]0-12The present study was
undertaken to compare the haemodynamic effects of
rocuroniu (...truncated)