pancuronium and Coronary-Artery-Disease

The safety and efficacy of propofol, a new intravenous anesthetic agent, have been demonstrated in healthy patients. Twenty-one patients, ASA III-IV, undergoing elective myocardial revascularization, were randomly chosen to receive either propofol, 2.5 mg/kg, or thiamylal, 4 mg/kg. for the induction of anesthesia. Hemodynamics were recorded at one and three minutes after drug administration during spontaneous respiration. After the addition of halothane and pancuronium with controlled ventilation, measurements were made immediately prior to and one minute after intubation. Five patients were dropped from the study, four due to airway problems and one due to severe hypotension following an induction dose of propofol. Statistics were done using data from the remaining 16 patients, eight in each group. Administration of propofol resulted in significant decreases in mean arterial pressure (MAP), systemic vascular resistance (SVR), and left ventricular stroke work index (LVSWI); as well as an increase in heart rate (HR). These changes were further accentuated by the addition of halothane and pancuronium prior to intubation. Patients in the thiamylal group experienced no significant hemodynamic changes until halothane and pancuronium were added and controlled ventilation was instituted. With these additions, the thiamylal group showed significant decreases in MAP and LVSWI immediately prior to intubation. Both groups experienced significant increases in HR following intubation, but no evidence of myocardial ischemia was seen in either group. All other parameters returned toward control values. Propofol appeared to be safe and effective for the induction of anesthesia in this group of patients, although its hemodynamic effects were greater than those of thiamylal.

Topics: Adult; Aged; Anesthesia, Intravenous; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Blood Pressure; Coronary Artery Disease; Elective Surgical Procedures; Halothane; Heart Rate; Humans; Intubation, Intratracheal; Middle Aged; Myocardial Revascularization; Neuromuscular Nondepolarizing Agents; Pancuronium; Propofol; Respiration, Artificial; Thiamylal; Time Factors; Vascular Resistance

A method of rapid-sequence induction was studied in 18 patients undergoing coronary artery bypass grafting (CABG) to assess the adequacy of relaxation for endotracheal intubation without resulting in major changes in heart rate (HR). Ten patients received vercuronium, 0.2 mg/kg (V); and eight patients received vecuronium, 0.1 mg/kg, and pancuronium, 0.1 mg/kg (V + P). All patients then received fentanyl, 50 to 70 microg/kg, or sufentanil, 5 to 7 microg/kg, followed 60 seconds later by intubation. Patients were assessed for ulnar and mandibular nerve response to train-of-four (TOF) and tetanic (T) stimulation at 60 seconds; presence or absence of coughing or bucking; degree of vocal cord relaxation (1=none, 2=some, 3=complete relaxation); ability to intubate at 60 seconds; and changes in HR. At the time of intubation, 17 patients had four twitches to TOF and a positive response to T stimulation of the ulnar nerve, while all 18 patients had zero or one twitch to TOF and only four had a positive response to T stimulation of the mandibular nerve (P < .0001 for T and TOF, ulnar v mandibular). Coughing and bucking were not observed in any patient. Vocal cord position was "3" in 14 patients and "2" in four patients. All patients were intubated without difficulty. The mean change in HR was -4.1 beats/min for patients receiving V and +16.4 beats/min for those receiving V + P (P < .002 for change in HR), with two V + P patients developing tachycardia. It is concluded that the onset of neuromuscular blockade is more rapid in the distribution of the mandibular nerve than at the ulnar nerve; mandibular nerve stimulation is a better predictor of adequate intubating conditions; good intubating conditions can be attained with either V or V + P; and, rapid-sequence induction with V is safe from a cardiac standpoint as measured by changes in HR, but the addition of pancuronium is unnecessary.

Topics: Anesthetics, Combined; Coronary Artery Bypass; Coronary Artery Disease; Dose-Response Relationship, Drug; Female; Fentanyl; Heart Rate; Humans; Intubation, Intratracheal; Male; Mandibular Nerve; Middle Aged; Muscle Relaxation; Narcotics; Neuromuscular Nondepolarizing Agents; Pancuronium; Sufentanil; Time Factors; Ulnar Nerve; Vecuronium Bromide; Vocal Cords