Abstract
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) iv before induction of anaesthesia with sufentanil (3–8 μg · kg−1). Vecuronium (0.1 mg · kg−1) was administered to facilitate tracheal intubation. According to random allocation, each patient received either pipecuronium (150 μg · kg−1) or pancuronium (120 μg · kg−1) after stemotomy but before heparinization. Mean arterial pressure, central venous pressure (CVP), pulmonary artery pressure (PAP), ST segment position and ECG (leads HI, 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.
Résumé
Cette étude compare les effets hémodynamiques et myocardiques du pipécuronium et du pancuronium auprès de patients soumis à une revascularisation myocardique sous anesthésie par benzodiazépine/sufentanil. Vingt-sept patients ASA III–IV reçoivent du lorazepam (1–3 mg)per os et du midazolam (<0,1 mg · kg−1) iv avant une induction anesthésique au sufentanil (3–8μg · kg−1). Du vécuronium (0,1 mg · kg−1) est administré pour permettre l’intubation. Une fois réparti au hasard, chaque patient reçoit du pipécuronium (150 μg · kg−1) ou du pancuronium (120 μg · kg−1) après la stemotomie mais avant l’hèparinisation. La pression artérielle moyenne (PAM), la tension veineuse centrale (TVC), la pression artérielle pulmonaire (PAP), la configuration du segment ST et l’ECG (dérivations II, V5, AVF) sont monitorés pendant l’intervention. Des mesure du débit cardiaque (DC) à trois exemplaires par thermodilution sont effectuées immédiatement avant ainsi qu’à la deuxième et cinquième minutes qui suivent l’administration du myorésolutif. Des images échocardiographiques transoesophagiennes (ETE) sur plusieurs plans (médio-papillires sur l’axe court du ventricule gauche) sont enregistrées continuellement à partir de dix minutes avant jusqu’à dix minutes après l’administration du myorelaxant et évaluées par deux anesthésistes expérimentés. La fréquence cardiaque, la PAM et le DC augmentent après l’administration du pancuronium (respectivement par 13,6 battements · min−1, 10,8 mmHg et 1,0 L· min−1) mais pas après le pipécuronium (P< 0,05). On n’a pas détecté d’ischémie myocardique chez aucun patient par l’analyse du segment ST ou par l’évaluation de la motilité ventriculaire gauche par ETE. Nous concluons que le pancuronium produit des augmentations de la Fc, de la PAM et du DC mais ni la pipécuronium ni la pancuronium ne provoque de l’ischémie myocardique.
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Shorten, G.D., Sieber, T., Maslow, A.D. et al. Left ventricular regional wall motion and haemodynamic changes following bolus administration of pipecuronium or pancuronium to adult patients undergoing coronary artery bypass grafting. Can J Anaesth 42, 695–700 (1995). https://doi.org/10.1007/BF03012667
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DOI: https://doi.org/10.1007/BF03012667