pancuronium and Heart-Valve-Diseases

Topics: Adult; Analgesics, Opioid; Anesthesia; Anesthetics, Intravenous; Anticonvulsants; Cardiopulmonary Bypass; Diazepam; Etomidate; Female; Fentanyl; Heart Valve Diseases; Heparin; Humans; Midazolam; Morphine; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Pancuronium; Piperidines; Propofol; Remifentanil; Stiff-Person Syndrome

The efficacy and safety of nalbuphine hydrochloride as an IV analgesic used in combination with pretreatment and supplemental doses of diazepam with and without N2O were assessed in 15 patients scheduled to undergo aortocoronary bypass (n = 11) or valve replacement surgery (n = 4). The loading infusion of 3.0 mg/kg nalbuphine given in 20 min 5 min after conclusion of IV injection of 0.4 mg/kg/5 min diazepam caused no significant changes in systolic or diastolic systemic and pulmonary arterial blood pressures or in heart rate, cardiac index, stroke index, systemic and pulmonary vascular resistance, or right and left ventricular stroke work index. After the initial 1-hr loading infusion of 6.66 +/- 0.89 mg/kg nalbuphine (mean +/- SE), additional nalbuphine infusion maintenance doses of 4.73 +/- 0.77, 1.87 +/- 0.31, 2.16 +/- 0.23, 1.65 +/- 0.22, and 2.35 +/- 0.44 were used in the subsequent hourly periods to maintain a pain-free state throughout surgery. Hemodynamic changes during the three most stressful periods, tracheal intubation, skin incision, and sternotomy, were not statistically significant. Normal plasma catecholamine and cortisol levels indicate that these patients experienced neither stress nor pain during the maintenance of anesthesia. Nalbuphine caused no significant histamine release. All patients had uncomplicated maintenance of and emergence from anesthesia.

Topics: Adult; Aged; Analgesia; Anesthesia Recovery Period; Catecholamines; Coronary Artery Bypass; Diazepam; Double-Blind Method; Drug Administration Schedule; Female; Heart Valve Diseases; Hemodynamics; Humans; Male; Middle Aged; Morphinans; Nalbuphine; Nitrous Oxide; Pancuronium; Random Allocation

Middle-latency auditory evoked responses (MLRs) were recorded from infants and adults before and during open heart surgery. Hypothermia was induced through perfusion cooling by cardiopulmonary bypass. In infants deep hypothermia (to 15 degrees C nasopharyngeal temp.) was often followed by the induction of total circulatory arrest. In adults nasopharyngeal temperatures of 25 degrees C were reached. The MLRs were elicited by unfiltered clicks presented through an insert type earphone and recorded with a vertex to ipsilateral earlobe electrode configuration. The MLRs proved to be resistant to muscle relaxation induced by pancuronium and to anesthesia induced and maintained in most cases by fentanyl. In most cases MLR peak latencies were progressively delayed as temperature decreased. Hypotension resulted in decreased MLR (Pa) amplitude.

Topics: Adolescent; Adult; Child; Coronary Artery Bypass; Electroencephalography; Evoked Potentials, Auditory; Female; Fentanyl; Halothane; Heart Defects, Congenital; Heart Valve Diseases; Humans; Hypothermia, Induced; Infant; Infant, Newborn; Male; Middle Aged; Pancuronium

The effects of induction of anaesthesia by etomidate 3 mg kg-1 followed by continuous infusion of etomidate 2 mg min-1, fentanyl 0.01 mg.kg-1 and pancuronium 0.1 mg.kg-1 were studied in ten patients with valvular heart disease. No haemodynamic changes were seen injection of etomidate, but after fentanyl was given there was a significant decline in cardiac index (10%), in mean arterial systemic pressure (20%), in systemic vascular resistance (14%), in left ventricular minute work index (27%) and in right ventricular minute work index (21%) compared to the control values. After supplementing with pancuronium, no further significant changes were seen. There was no significant change in the pulmonary vascular resistance during the whole study. In conclusion, it appears that etomidate is a safe intravenous agent, and is worth further study, in particular in patients with minimal cardiac reserve requiring high inspired oxygen tension.

Topics: Adult; Aged; Anesthesia; Etomidate; Female; Fentanyl; Heart Valve Diseases; Hemodynamics; Humans; Imidazoles; Male; Middle Aged; Pancuronium; Vascular Resistance

This article reports the utilization of acupuncture in combination with chemical anesthesia and neuromuscular relaxant for patients with cardiac surgery, including valvular disease and by-pass. In 800 patients studied using this type of combination of anesthetic techniques, it was found that this procedure can be successful for cardiac surgery and that it allows light planes of anesthesia with less interference to circulatory regulation. There is a certain advantage of using acupuncture anesthesia when compared with chemical anesthesia, as the pharmacological agents are not used and hence post no metabolic load for the patients. From the 800 patients studied, it seems justifiable to recommend this anesthetic procedure for cardiac surgery.

Topics: Acupuncture Therapy; Adult; Anesthesia; Blood Pressure; Cardiac Surgical Procedures; Coronary Artery Bypass; Electric Stimulation; Female; Heart Rate; Heart Valve Diseases; Humans; Male; Middle Aged; Pancuronium; Postoperative Care; Preoperative Care; Vasodilator Agents

The effects of enflurane-pancuronium anaesthesia on cardiovascular haemodynamics were studied before operation in six patients with valvular heart disease. A ten per cent decline in cardiac index and a 20 per cent decline in stroke volume were the only changes observed. Mean arterial, pulmonary arterial, contral venous, and pulmonary capillary wedge pressures were unaffected, as were systemic vascular resistance and pulmonary vascular resistance. The authors therefore conclude that enflurane-pancuronium anaesthesia causes only minimal cardiovascular depression in patients with valvular heart disease.

Topics: Anesthesia; Blood Pressure; Cardiac Output; Enflurane; Female; Heart Valve Diseases; Hemodynamics; Humans; Male; Methyl Ethers; Middle Aged; Pancuronium

Comparison is made between 45 cases treated with d-tubocurarine and 60 with pancuronium bromide in open-heart surgery. Pancuronium displayed unmistakable advantages in the form of a more potent action, rapid commencement and long duration, dose flexibility and an almost complete absence of undesirable side-effects. In addition, it offered stability with respect to the cardiovascular system and enabled risk-free, deep muscle relaxation to be achieved even in subjects with complex cardiopathies, such as those with pulmonary hypertension, extreme hypoplasia or aplasia of the trunk of the pulmonary artery and patent ductus arteriosus, for whom a very high operative mortality risk exists when even minimal changes in cardiovascular parameters occur.

Topics: Adjuvants, Anesthesia; Adolescent; Adult; Cardiac Surgical Procedures; Child; Child, Preschool; Extracorporeal Circulation; Female; Heart Defects, Congenital; Heart Valve Diseases; Humans; Infant; Male; Middle Aged; Pancuronium; Preanesthetic Medication; Tubocurarine