Rocuronium versus vecuronium during fentanyl induction in patients undergoing coronary artery surgery

Objective: To evaluate the neuromuscular, ventilatory, and cardiovascular e ffects of rocuronium and vecuronium. Design: Randomized, prospective, blinded study. Setting: Tertiary care teaching center, single institution. Participants: Patients undergoing elective coronary artery bypass graft pro cedure. Interventions: Patients received rocuronium, 1.0 mg/kg (n = 17), or vecuron ium, 0.15 mg/kg (0 = 15), during fentanyl induction of anesthesia. Measurements and Main Results: Measures consisted of time to visual loss of orbicularis oculi twitches in response to facial nerve stimulation, ease o f mask ventilation, hemodynamics, need for vasoactive drugs, and tracheal i ntubating conditions. Median time to twitch loss was faster (p < 0.05) afte r rocuronium (60 s) than after vecuronium (>84 s). Within 45 seconds, only 3 of 17 patients in the rocuronium group had moderate-to-severe difficulty with mask ventilation versus 12 of 15 patients in the vecuronium group (p < 0.05). Tracheal intubating conditions were excellent in all patients after rocuronium. In the vecuronium group, intubating conditions were excellent in 46%, good in 27%, and poor in 27% (p < 0.05 v rocuronium). Patients rece iving vecuronium were more likely to require ephedrine and phenylephrine fo r hypotension (10/15 patients v 5/17 patients for rocuronium, p < 0.05). Th ere were no clinically important differences in hemodynamic variables, oxyg en metabolism, or myocardial ischemia between groups. Conclusion: During narcotic induction of anesthesia, rocuronium was associa ted with lower requirement for vasopressors, faster onset of neuromuscular blockade, and better conditions for mask ventilation and tracheal intubatio n compared with vecuronium. Copyright (C) 1999 by W.B. Saunders Company.