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Hemodynamic Effects of Metocurine in Patients with Coronary Artery Disease Receiving Propranolol

JAMES ZAIDAN, MD^*, DANIEL M. PHILBIN, MD, ROBERT ANTONIO, MD, and JOHN SAVARESE, MD

*Fellow in Anesthesia. Assistant Professor of Anesthesiology. Fellow in Anesthesia.

Abstract

This study was undertaken to determine the circulatory effects of metocurine (dimethyltubo-curarine) in 7 men scheduled for coronary artery surgery who had been receiving propranolol for at least 6 weeks before morphine-N₂O-O₂ anesthesia. The study was divided into 4 measurement periods: (1) control after induction; (2) 5 minutes after administration of 0.35 mg/ kg of metocurine; (3) 10 minutes after; (4) 20 minutes after. There were no significant changes in mean blood pressure, heart rate (HR), central venous pressure or arterial blood gases throughout the study. Cardiac index rose significantly from a control value of 1.89±0.1 L/min/m² to 2.39±0.2 L/min/m² in period 2 and remained elevated throughout (2.53±0.3 and 2.33±0.2 L/min/m²). Systemic vascular resistance (SVR) fell from a control value of 20.2±1.8 units to 16.1±1.6 units in period 2 and remained below control in periods 3 and 4 (17.2±1.8 and 16.9±1.3).

These data suggest that metocurine produced a significant decrease in SVR in the presence of propranolol, resulting in an increase in cardiac output (and stroke volume) in a compensated heart, to maintain perfusion pressure. The possibility of a central (cardiac) effect cannot be excluded, but the lack of an increase in HR suggests it would not be clinically significant.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999