HEMODYNAMIC-EFFECTS OF HIGH-DOSE VECURONIUM COMPARED WITH PANCURONIUMIN BETA-BLOCKED PATIENTS WITH CORONARY-ARTERY DISEASE DURING FENTANYL-DIAZEPAM-NITROUS OXIDE ANESTHESIA

Background. Different combinations of neuromuscular blockers and opioi ds have been used in patients with angina pectoris to provide cardiova scular stability and reduce risk of myocardial ischaemia during anaest hesia. Methods. We have compared the haemodynamic effects of high-dose vecuronium (0.3 mg kg(-1)) with those of a standard dose of pancuroni um (0.1 mg kg(-1)) in patients scheduled for coronary artery bypass gr afting during fentanyl-diazepam-nitrous oxide anaesthesia. All patient s were receiving beta-adrenergic blocking agents. The given doses of v ecuronium and pancuronium are equieffective with respect to duration o f neuromuscular blockade. Results. During a 25-min experimental period following the administration of the randomly selected drug, no signif icant changes in the haemodynamic parameters were observed in the vecu ronium group. The administration of pancuronium, however, resulted in a significant mean increase in heart rate (20%), rate-pressure product (23%) and cardiac index (21%). Following endotracheal intubation in t he pancuronium group, we observed an additional significant increase i n mean arterial pressure and rate-pressure product. Conclusion. High-d ose administration of vecuronium has minimal haemodynamic effects and may thus offer a better alternative than pancuronium for long-lasting neuromuscular blockade in patients with coronary artery disease during fentanyl-diazepam-nitrous oxide anaesthesia.