TY - JOUR
T1 - Hemodynamic effects of muscle relaxant drugs during anesthetic induction in patients with mitral or aortic valvular heart disease
AU - Larach, David R.
AU - Hensley, Frederick A.
AU - Martin, Donald E.
AU - High, Kane M.
AU - Rung, George W.
AU - Skeehan, Thomas M.
N1 - Funding Information:
From the Department of Anesthesia, College of Medicine, The Pennsylvania State University, Hershey, PA. Supported in part by grants from Organen Inc, West Orange, NJ, and the Department ofAnesthesia, The Pennsylvania State University, Hershey, PA. Address reprint requests to David R Larach, MD, PhD, Department of Anesthesia, The Pennsylvania State University, PO Box 8.50, Hershey, PA 17033. Copyright 0 1991 by W. B. Saunders Company 1053-0770191/0502-0006$03.0010
Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 1991/4
Y1 - 1991/4
N2 - The hemodynamic effects of three nondepolarizing skeletal muscle relaxant drug regimens were compared during the induction of general anesthesia in 64 patients with valvular heart disease using a double-blind protocol. Patients were first stratified according to primary valvular defect (aortic stenosis, aortic regurgitation, mitral stenosis, or mitral regurgitation). Next, patients were randomly allocated to a drug group, either group A (atracurium), group V (vecuronium), or group MP (metocurine plus pancuronium). Data were collected during three periods: awake, postanesthetic induction, and posttracheal intubation. Four cardiovascular variables were designated a priori as primary variables of interest. These were heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), and systemic vascular resistance index (SVRI). Patients with mitral stenosis showed two significant hemodynamic differences among muscle relaxant drug groups: (1) Cl increased in group A but decreased in group MP between the awake and postinduction measurements (P = 0.032); and (2) SVRI decreased in group A but increased in group MP between the awake and postintubation periods (P = 0.034). In contrast, patients with aortic stenosis, aortic regurgitation, or mitral regurgitation demonstrated no statistically significant difference in cardiovascular responses among drug groups. Further analysis was performed using the following data: (1) other hemodynamic variables; (2) incidence of deviations from cardiovascular stability; and (3) the frequency of cardiovascular drug use. This examination showed no important differences among the muscle relaxant drug groups. The small but significant hemodynamic changes observed in mitral stenosis patients in drug groups A and MP were not noted with vecuronium. The authors conclude that the muscle relaxant regimens of atracurium, vecuronium, or metocurine plus pancuronium can each provide hemodynamic stability when used in patients with severe valvular heart disease.
AB - The hemodynamic effects of three nondepolarizing skeletal muscle relaxant drug regimens were compared during the induction of general anesthesia in 64 patients with valvular heart disease using a double-blind protocol. Patients were first stratified according to primary valvular defect (aortic stenosis, aortic regurgitation, mitral stenosis, or mitral regurgitation). Next, patients were randomly allocated to a drug group, either group A (atracurium), group V (vecuronium), or group MP (metocurine plus pancuronium). Data were collected during three periods: awake, postanesthetic induction, and posttracheal intubation. Four cardiovascular variables were designated a priori as primary variables of interest. These were heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), and systemic vascular resistance index (SVRI). Patients with mitral stenosis showed two significant hemodynamic differences among muscle relaxant drug groups: (1) Cl increased in group A but decreased in group MP between the awake and postinduction measurements (P = 0.032); and (2) SVRI decreased in group A but increased in group MP between the awake and postintubation periods (P = 0.034). In contrast, patients with aortic stenosis, aortic regurgitation, or mitral regurgitation demonstrated no statistically significant difference in cardiovascular responses among drug groups. Further analysis was performed using the following data: (1) other hemodynamic variables; (2) incidence of deviations from cardiovascular stability; and (3) the frequency of cardiovascular drug use. This examination showed no important differences among the muscle relaxant drug groups. The small but significant hemodynamic changes observed in mitral stenosis patients in drug groups A and MP were not noted with vecuronium. The authors conclude that the muscle relaxant regimens of atracurium, vecuronium, or metocurine plus pancuronium can each provide hemodynamic stability when used in patients with severe valvular heart disease.
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U2 - 10.1016/1053-0770(91)90323-L
DO - 10.1016/1053-0770(91)90323-L
M3 - Article
C2 - 1677822
AN - SCOPUS:0025801621
SN - 1053-0770
VL - 5
SP - 126
EP - 131
JO - Journal of cardiothoracic and vascular anesthesia
JF - Journal of cardiothoracic and vascular anesthesia
IS - 2
ER -