pancuronium and Myocardial-Ischemia

The objective of this study was to compare the haemodynamic and myocardial effects of pipecuronium and pancuronium in patients undergoing coronary artery bypass grafting (CABG) during benzodiazepine/sufentanil anaesthesia. Twenty-seven ASA III-IV patients received lorazepam (1-3 mg) po and midazolam ( < 0.1 mg.kg-1) i.v. before induction of anaesthesia with sufentanil (3-8 micrograms.kg-1) was administered to facilitate tracheal intubation. According to random allocation, each patient received either pipecuronium (150 micrograms.kg-1) or pancuronium (120 micrograms.kg-1) after sternotomy but before heparinization. Mean arterial pressure, central venous pressure (CVP), pulmonary artery pressure (PAP), ST segment position and ECG (leads III, V5, AVF) were monitored continuously throughout the procedure. Thermodilution determinations of CO in triplicate were made immediately before, and at two and five minutes after muscle relaxant administration. Multiplane transoesophageal echocardiography (TEE, midpapillary short axis views of the left ventricle) images were continuously recorded from ten minutes before until ten minutes after muscle relaxant administration and graded by two experienced echocardiographic readers. Heart rate, MAP and CO increased after administration of pancuronium (by 13.6 beats.min-1, 10.8 mmHg and 1.0 L.min-1 respectively) but not after pipecuronium (P < 0.05). Evidence of myocardial ischaemia was not detected in any patients using ECG ST segment analysis or TEE assessment of left ventricular wall motion. We conclude that pancuronium caused increases in HR, MAP and CO but that neither pancuronium nor pipecuronium caused myocardial ischaemia.

Topics: Adult; Aged; Anesthetics, Intravenous; Blood Pressure; Cardiac Output; Central Venous Pressure; Coronary Artery Bypass; Echocardiography, Transesophageal; Electrocardiography; Female; Heart Rate; Humans; Hypnotics and Sedatives; Lorazepam; Male; Midazolam; Middle Aged; Myocardial Ischemia; Neuromuscular Nondepolarizing Agents; Pancuronium; Pipecuronium; Sufentanil; Thoracotomy; Vecuronium Bromide; Ventricular Function, Left

Topics: Anesthesia, Intravenous; Cardiopulmonary Bypass; Clonidine; Double-Blind Method; Electrocardiography; Humans; Incidence; Midazolam; Myocardial Ischemia; Pancuronium; Pilot Projects; Placebos; Sufentanil

To determine the incidence, triggers, and timing of myocardial injury during reoperation for coronary artery bypass surgery.. Prospective observational.. One tertiary care university hospital.. 15 patients undergoing reoperation.. Multilead electrocardiographic monitoring approximately every 3 minutes during surgery.. The occurrence of a new ischemic ST elevation or depression on the electrocardiogram (ECG) was determined. A major deterioration in ventricular function after cardiopulmonary bypass (CPB) also was determined. Peak creatine kinase myocardial band (CK-MB) > or = 25 IU/L was considered to be the marker of myocardial injury. Seven patients demonstrated myocardial injury, all intraoperatively. Five of these patients had new ST elevation episodes before CPB. Three of the episodes were temporally associated with an abrupt increase in the heart rate. The other two episodes were temporally associated with surgical manipulation of the heart and the old grafts. The sixth patient had a significant deterioration of ventricular function during CPB. One of the patients who had ST elevation before CPB and the seventh patient developed ST elevation towards the end of protamine administration.. In patients undergoing reoperation, the intraoperative incidence of myocardial injury, especially before CPB, was found to be substantially higher than that previously reported.

Topics: Aged; Arrhythmias, Cardiac; Cardiopulmonary Bypass; Case-Control Studies; Coronary Artery Bypass; Coronary Disease; Creatine Kinase; Electrocardiography; Female; Heart Rate; Heparin Antagonists; Humans; Incidence; Intraoperative Complications; Intubation, Intratracheal; Isoenzymes; Male; Middle Aged; Monitoring, Intraoperative; Myocardial Ischemia; Neuromuscular Nondepolarizing Agents; Pancuronium; Prospective Studies; Protamines; Reoperation; Ventricular Dysfunction

Topics: Anesthetics; Blood Pressure; Cardiac Output; Coronary Disease; Drug Interactions; Heart; Heart Rate; Humans; Myocardial Ischemia; Narcotics; Neuromuscular Nondepolarizing Agents; Norepinephrine; Pancuronium; Pipecuronium