Hemodynamic effects of muscle relaxant drugs during anesthetic induction in patients with mitral or aortic valvular heart disease.
The hemodynamic effects of three nondepolarizing skeletal muscle relaxant drug regimens were compared during the induction of general anesthesia in 64 patients with valvular heart disease using a double-blind protocol. Patients were first stratified according to primary valvular defect (aortic stenosis, aortic regurgitation, mitral stenosis, or mitral regurgitation). Next, patients were randomly allocated to a drug group, either group A (atracurium), group V (vecuronium), or group MP (metocurine plus pancuronium). Data were collected during three periods: awake, postanesthetic induction, and posttracheal intubation. Four cardiovascular variables were designated a priori as primary variables of interest. These were heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), and systemic vascular resistance index (SVRI). Patients with mitral stenosis showed two significant hemodynamic differences among muscle relaxant drug groups: (1) CI increased in group A but decreased in group MP between the awake and postinduction measurements (P = 0.032); and (2) SVRI decreased in group A but increased in group MP between the awake and postintubation periods (P = 0.034). In contrast, patients with aortic stenosis, aortic regurgitation, or mitral regurgitation demonstrated no statistically significant difference in cardiovascular responses among drug groups. Further analysis was performed using the following data: (1) other hemodynamic variables; (2) incidence of deviations from cardiovascular stability; and (3) the frequency of cardiovascular drug use. This examination showed no important differences among the muscle relaxant drug groups. The small but significant hemodynamic changes observed in mitral stenosis patients in drug groups A and MP were not noted with vecuronium.(ABSTRACT TRUNCATED AT 250 WORDS)
Larach
D R
DR
Department of Anesthesia, College of Medicine, Pennsylvania State University, Hershey 17033.
Hensley
F A
FA
Martin
D E
DE
High
K M
KM
Rung
G W
GW
Skeehan
T M
TM
D000771:Anesthesia, Intravenous; D001022:Aortic Valve Insufficiency / Q000503:physiopathology* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000503:physiopathology* / Q000601:surgery; D001279:Atracurium / Q000008:administration & dosage / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology* / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000503:physiopathology* / Q000601:surgery; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000494:pharmacology*; D010197:Pancuronium / Q000008:administration & dosage / Q000494:pharmacology; D011446:Prospective Studies; D013997:Time Factors; D014403:Tubocurarine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology; D014655:Vascular Resistance / Q000187:drug effects; D014673:Vecuronium Bromide / Q000008:administration & dosage / Q000494:pharmacology
D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D014673:Vecuronium Bromide; D010197:Pancuronium; C032943:metocurine; D014403:Tubocurarine