title: Influence of beta-blockers on vecuronium/sufentanil or pancuronium/sufentanil combinations for rapid induction and intubation of cardiac surgical patients.
abstract: Use of pancuronium or vecuronium with the priming principle was evaluated in regards to hemodynamic changes and adequacy of relaxation for a rapid induction-endotracheal intubation sequence with sufentanil in 24 ASA Class III-IV patients undergoing cardiac surgery. Twelve patients taking beta-blockers (groups B-P and B-V) were compared with 12 patients not receiving beta-blockers (groups NB-P and NB-V). Patients randomly received vecuronium or pancuronium (15 microg/kg), followed in 4 minutes by sufentanil 5 microg/kg and another 85 microg/kg of the appropriate relaxant through a central vein. Intubation was possible in all patients at 90 seconds with good-to-excellent conditions. Heart rate (HR) remained statistically elevated after induction (90 +/- 10 beats/min) and intubation (105 +/- 10 beats/min) only in group NB-P (baseline 74 +/- 12 beats/min). The NB-P group also had an elevated blood pressure after the priming dose. No significant hemodynamic changes were found in the other groups in mean arterial pressure, pulmonary artery diastolic pressure, systemic vascular resistance (SVRI), or cardiac index (CI). When used with vecuronium, sufentanil in a dose of 5 microg/kg provided adequate anesthesia to avoid the hypertensive, tachycardic response that frequently occurs following a rapid intravenous (IV) induction, without unduly depressing cardiac output or arterial pressure. Two patients had evidence of respiratory difficulty after the priming dose, associated with transient tachycardia and hypertension which resolved after induction. Using the priming principle, either pancuronium or vecuronium rapidly provided relaxation in patients with cardiac disease. Chronic beta-blocker therapy was able to attenuate the tachycardia from pancuronium and was not associated with bradycardia when used with vecuronium. In patients with cardiac disease not on beta-blockers, pancuronium was associated with tachycardia. Therefore, vecuronium appears to be more suitable for these patients.
authors.affiliation: Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, USA.
authors.forename: K
authors.initials: K
authors.lastname: Zahl
authors.forename: N
authors.initials: N
authors.lastname: Ellison
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000758:Anesthesia / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects; D006348:Cardiac Surgical Procedures; D004562:Electrocardiography / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D010197:Pancuronium / Q000008:administration & dosage*; D017409:Sufentanil / Q000008:administration & dosage*; D014673:Vecuronium Bromide / Q000008:administration & dosage*
chemical_list: D000319:Adrenergic beta-Antagonists; D014673:Vecuronium Bromide; D017409:Sufentanil; D010197:Pancuronium