High-dose vecuronium neuromuscular block: a comparison of arrhythmias and onset of block during sufentanil anaesthesia.
This study compared the heamodynamic effects of sufentanil with those observed following concomitant sufentanil and high-dose vecuronium administration to determine whether vecuronium induces bradyarrhythmias. Sixty coronary artery bypass patients were stratified into beta blocker (n = 30) or non-beta blocker (n = 30) groups and following induction with sufentanil (9 +/- 3 micrograms.kg-1) and midazolam (0.07 +/- 0.04 mg.kg-1), received either succinylcholine 1 mg.kg-1 (SxCh), vecuronium 0.3 mg.kg-1 (Vec 0.3), or vecuronium 0.5 mg.kg-1 (Vec 0.5). Using a Holter ECG monitor, bradyarrhythmias were classified as mild (HR 46-50), moderate (HR 40-45) or severe (HR < 40). In the pre-induction period, there were no differences in the incidence of mild, moderate or severe bradyarrhythmias among the SxCh, Vec 0.3 or Vec 0.5 groups, in either the beta blocker or non-beta blocker groups. Following induction, there were similar reductions in mean heart rate and mean arterial pressure in all three muscle relaxant groups in both the beta and the non-beta blocker groups; however, there was no difference in the incidence of mild, moderate or severe bradyarrhythmias among the SxCh, Vec 0.3 or Vec 0.5 groups. The Vec 0.5 beta blocker group had a higher incidence of mild bradyarrhythmias (32 +/- 36%) than the Vec 0.5 non-beta blocker group (2 +/- 3%, P = 0.017). Using EMG recording, the onset time of maximal neuromuscular block for the Vec 0.3 group (108 +/- 17 sec) was longer (P < 0.05) than the SxCh (76 +/- 21 sec) and Vec 0.5 (82 +/- 13 sec) groups, which were similar.(ABSTRACT TRUNCATED AT 250 WORDS)
Sharpe
M D
MD
Department of Anaesthesia, University Hospital, University of Western Ontario, London, Canada.
Murkin
J M
JM
Vannelli
T
T
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D001919:Bradycardia / Q000139:chemically induced*; D002302:Cardiac Output / Q000187:drug effects; D001026:Coronary Artery Bypass; D004347:Drug Interactions; D015716:Electrocardiography, Ambulatory; D004576:Electromyography; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage* / Q000009:adverse effects; D013390:Succinylcholine / Q000008:administration & dosage; D017409:Sufentanil / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D014673:Vecuronium Bromide / Q000008:administration & dosage* / Q000009:adverse effects
D000319:Adrenergic beta-Antagonists; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D017409:Sufentanil; D013390:Succinylcholine; D008874:Midazolam