[The effect of pancuronium and norcuron on hemodynamics, coronary circulation and myocardial oxygen consumption in coronary surgery patients].
The effects of the non-depolarizing muscle relaxants pancuronium (Pancuronium) and vecuronium (Norcuron) (0.1 mg/kg) on myocardial blood flow, myocardial oxygen consumption, myocardial lactate balance, cardiovascular dynamics and electrocardiogram were studied in two groups of eight patients undergoing coronary artery bypass surgery. After an introduction of anaesthesia with 0.015-0.02 mg/kg rohypnol, isoflurane (0.5 Vol%) and N2O/O2 neuromuscular blockade was induced with pancuronium or vecuronium combined with a single dose of 0.005 mg/kg fentanyl. Measurements and electrocardiogram were performed before anaesthesia, in steady state of anaesthesia and after relaxation with pancuronium or vecuronium, combined with fentanyl. The measurements consisted of heart rate (HR), cardiac index (CI), stroke volume index (SVI), mean arterial pressure (AP), total peripheral resistance (TPR), pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP), right atrium pressure (RAP), myocardial blood flow (MBF), coronary vascular resistance (CVR), myocardial oxygen consumption (MVO2), coronary ateriomixed venous oxygen content difference (AVDO2cor), myocardial lactate extraction (LE) and rate pressure product (RPP). In the vecuronium group heart rate (HR) decreased significantly greater (21%) than in the pancuronium group (9%). Therefore myocardial oxygen consumption (MVO2) and coronary blood flow (CBF) diminished more in the vecuronium (48% resp. 35%) than in the pancuronium group (31% resp. 18%). The higher metabolic demand in the pancuronium group induced a significantly lower coronary vascular resistance (CVR). All the other hemodynamic parameters did not differ significantly in both patients groups. In all the patients we could not observe ST-segment depressions or elevations in the ECG, increases of PCWP or myocardial lactate productions.(ABSTRACT TRUNCATED AT 250 WORDS)
Günnicker
M
M
Institut für Anaesthesiologie, Universitätsklinikum Essen der Gesamthochschule Essen.
Hirche
H
H
Pohlen
G
G
Hess
W
W
D000368:Aged; D000768:Anesthesia, General; D001026:Coronary Artery Bypass; D003326:Coronary Circulation / Q000187:drug effects*; D003327:Coronary Disease / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005283:Fentanyl; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D010101:Oxygen Consumption / Q000187:drug effects*; D010197:Pancuronium; D014673:Vecuronium Bromide
D007773:Lactates; D019344:Lactic Acid; D014673:Vecuronium Bromide; D010197:Pancuronium; D005283:Fentanyl
Der Einfluss von Pancuronium und Norcuron auf die Hämodynamik, die Koronardurchblutung und den myokardialen Sauerstoffverbrauch bei koronarchirurgischen Patienten.