Rocuronium versus vecuronium during fentanyl induction in patients undergoing coronary artery surgery.
OBJECTIVE
To evaluate the neuromuscular, ventilatory, and cardiovascular effects of rocuronium and vecuronium.


METHODS
Randomized, prospective, blinded study.


METHODS
Tertiary care teaching center, single institution.


METHODS
Patients undergoing elective coronary artery bypass graft procedure.


METHODS
Patients received rocuronium, 1.0 mg/kg (n = 17), or vecuronium, 0.15 mg/kg (n = 15), during fentanyl induction of anesthesia.


RESULTS
Measures consisted of time to visual loss of orbicularis oculi twitches in response to facial nerve stimulation, ease of mask ventilation, hemodynamics, need for vasoactive drugs, and tracheal intubating conditions. Median time to twitch loss was faster (p < 0.05) after rocuronium (60 s) than after vecuronium (>84 s). Within 45 seconds, only 3 of 17 patients in the rocuronium group had moderate-to-severe difficulty with mask ventilation versus 12 of 15 patients in the vecuronium group (p < 0.05). Tracheal intubating conditions were excellent in all patients after rocuronium. In the vecuronium group, intubating conditions were excellent in 46%, good in 27%, and poor in 27% (p < 0.05 vrocuronium). Patients receiving vecuronium were more likely to require ephedrine and phenylephrine for hypotension (10/15 patients v 5/17 patients for rocuronium, p < 0.05). There were no clinically important differences in hemodynamic variables, oxygen metabolism, or myocardial ischemia between groups.


CONCLUSIONS
During narcotic induction of anesthesia, rocuronium was associated with lower requirement for vasopressors, faster onset of neuromuscular blockade, and better conditions for mask ventilation and tracheal intubation compared with vecuronium.
Smith
C E
CE
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA.
Botero
C
C
Holbrook
C
C
Pinchak
A C
AC
Hagen
J F
JF
D000732:Androstanols / Q000009:adverse effects / Q000494:pharmacology; D000758:Anesthesia; D018686:Anesthetics, Intravenous; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects / Q000494:pharmacology; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000187:drug effects; D011446:Prospective Studies; D012121:Respiration, Artificial; D000077123:Rocuronium; D014673:Vecuronium Bromide / Q000009:adverse effects / Q000494:pharmacology
D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D010100:Oxygen; D005283:Fentanyl; D000077123:Rocuronium