74087
document
Cardiovascular effects of non-depolarizing neuromuscular blockers in patients with aortic valve disease . To compare haemodynamic responses associated with equipotent doses of neuromuscular blockers and high-dose fentanyl ( 50 micrograms.kg-1 ) , 40 patients with aortic valve stenosis ( AS ) and 20 patients with aortic insufficiency ( AI ) were randomized to four study groups to receive the following : ( 1 ) pancuronium 0.12 mg.kg-1 , ( 2 ) vecuronium 0.12 mg.kg-1 , ( 3 ) atracurium 0.4 mg.kg-1 , or ( 4 ) pancuronium-metocurine mixture ( 0.4 mg + 1.6 mg/ml ) : 1 ml/10 kg ) . Neuromuscular blockers were injected at the same time with the fentanyl ; haemodynamics were recorded with the patients awake ( baseline ) , at two minutes post-induction , and at two and five minutes after intubation . In patients with AS , pancuronium increased heart rate more than vecuronium or atracurium ; heart rates were also higher with the pancuronium-metocurine mixture than with vecuronium . Although there were no ECG signs of ischaemia , one patient given pancuronium developed severe hypotension associated with tachycardia . Reductions in SVR after atracurium allowed small but significant ( p less than 0.01 ) decreases in MAP which were well tolerated ; one patient , however , did develop severe hypotension . Intubation resulted in significant ( p less than 0.01 ) increases in MAP in the pancuronium-metocurine mixture group . Vecuronium permitted the most stable overall haemodynamic course at all measurement times . In contrast , patients with AI showed stable haemodynamics after vecuronium , pancuronium and the pancuronium-metocurine mixture ; one patient became tachycardic following vecuronium . Atracurium caused unexplained elevations in diastolic and mean arterial pressures which were significant when compared to vecuronium ( p less than 0.01 ) . These results in increases in PCWP ; mean PA pressures and CVP were also increased . These effects of atracurium inpatients with Al need further evaluation .
74088
Intervention_Pharmacological
non-depolarizing neuromuscular blockers
74089
Intervention_Pharmacological
neuromuscular blockers
74090
Intervention_Pharmacological
fentanyl
74091
Intervention_Pharmacological
pancuronium 0.12 mg.kg-1 , ( 2 ) vecuronium 0.12 mg.kg-1
74092
Intervention_Pharmacological
( 3 ) atracurium 0.4 mg.kg-1
74093
Intervention_Pharmacological
( 4 ) pancuronium-metocurine mixture
74094
Intervention_Pharmacological
Neuromuscular blockers
74095
Intervention_Pharmacological
fentanyl
74096
Intervention_Pharmacological
pancuronium
74097
Intervention_Pharmacological
vecuronium
74098
Intervention_Pharmacological
atracurium
74099
Intervention_Pharmacological
pancuronium-metocurine mixture
74100
Intervention_Pharmacological
vecuronium
74101
Intervention_Pharmacological
pancuronium-metocurine
74102
Intervention_Pharmacological
Vecuronium
74103
Intervention_Pharmacological
vecuronium
74104
Intervention_Pharmacological
pancuronium
74105
Intervention_Pharmacological
pancuronium-metocurine mixture
74106
Intervention_Pharmacological
vecuronium
74107
Intervention_Pharmacological
Atracurium
74108
Intervention_Pharmacological
vecuronium
74109
Intervention_Pharmacological
atracurium
74110
Outcome_Physical
heart rate
74111
Outcome_Physical
heart rates
74112
Outcome_Physical
ECG signs of ischaemia
74113
Outcome_Physical
severe hypotension associated with tachycardia
74114
Outcome_Physical
SVR
74115
Outcome_Physical
MAP
74116
Outcome_Other
well tolerated
74117
Outcome_Physical
severe hypotension
74118
Outcome_Physical
MAP
74119
Outcome_Physical
overall haemodynamic course
74120
Outcome_Physical
stable haemodynamics
74121
Outcome_Physical
tachycardic
74122
Outcome_Physical
elevations in diastolic and mean arterial pressures
74123
Outcome_Physical
PCWP
74124
Outcome_Physical
mean PA pressures
74125
Outcome_Physical
CVP
74126
Outcome_Other
increased