Couture P, Boudreault D, Girard D, Plante F, McKenty S, St-Pierre J, Poirier NL. Haemodynamic interaction of high-dose fentanyl and increasing doses of vecuronium in patients undergoing myocardial revascularization.
Acta Anaesthesiol Scand 1996;
40:32-8. [PMID:
8904257 DOI:
10.1111/j.1399-6576.1996.tb04385.x]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND
Bradyarrhythmia has been reported with vecuronium when given with high dose narcotics. We hypothesized that if the bradycardic response is dependent on a vagal reaction mediated by narcotics, it should be independent of the vecuronium dose. A dose-related response of vecuronium on heart rate (HR) would be in favour of a chronotropic action of this agent.
METHODS
We examined three induction techniques using high doses of fentanyl in which vecuronium was given in increasing doses. In addition, a reference group received a low dose of atracurium. Forty patients scheduled for elective CABG surgery were anaesthetized with fentanyl (50 mu g/kg) given over 5 min, and were randomly assigned to receive either 0.056, 0.14, 0.28 mg/kg of vecuronium or 0.28 mg/kg of atracurium. Haemodynamic measurements were obtained at the following intervals: before induction (time 0), after the administration of fentanyl (at 5 min), and 1, 2 and 5 min after tracheal intubation (at 10, 11 and 15 min).
RESULTS
In vecuronium-treated groups, there were significant decreases in HR, mean arterial pressure, and cardiac output (P<0.05). There were no differences between the three vecuronium groups. Although the atracurium-treated group displayed no significant haemodynamic changes, 2 patients of this group developed HR < 40 bpm.
CONCLUSIONS
Over the range of vecuronium doses studied, we observed a reduction in HR during induction for CABG surgery with high doses of fentanyl and vecuronium. This effect was not dose dependent and is likely related to a direct effect of a high-dose narcotic technique and/or due to a vagal stimulation regarding the airway procedure.
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