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Rapid Administration of a Narcotic and Neuromuscular Blocker

A Hemodynamic Comparison of Fentanyl, Sufentanil, Pancuronium, and Vecuronium

Received from the Department of Anesthesia, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina. Carolina.

Abstract

High-dose narcotic anesthetic inductions usually avoid circulatory depression bettrthan do other techniques; however, the selection of a narcotic and neuromuscular blocker influences subsequent hemodynamic responses. One hundred-one patients having aortocoronary bypass graft (CABG) surgery were investigated using four combinations of a narcotic and neuromuscular blocker: group FP (fentanyl 50 µg/kg, pancuronium 100 µg/kg); group FV (fentanyl 50 µg/kg, vecuronium 80 µg/kg); group SP (sufentanil 10 µg/kg, pancuronium 100 µg/kg); and group SV (sufentanil 10 µg/kg, vecuronium 80 µg/kg), each combination being administered over 2 minutes. Hemodynamic functions were then monitored for 10 minutes before tracheal intubation. Significant changes included increases in heart rate in the groups receiving pancuronium and decreases in those receiving vecuronium. In all groups mean arterial pressure initially decreased; systemic vascular resistance index decreased significantly in all groups except SV. Cardiac index decreased significantly only in group SV. Circulatory depression requiring treatment with vasopressor or anticholinergic drugs was more common in patients given vecuronium. Cardiac arrhythmia occurred most often in group SP; only in group FP were there no arrhythmias, ischemic changes, or hemodynamic disturbances requiring intervention. Time to onset of neuromuscular blockade did not differ among the four groups, but transient chest wall rigidity occurred significantly more often with sufentanil than with fentanyl. Overall, the fentanyl/pancuronium combination afforded the greatest hemodynamic stability, whereas the sufentanil/vecuronium combination proved least satisfactory because of bradycardia and hypotension, requiring treatment in 35% of group SV patients. Differences in anesthetic premedication, social habits, preoperative medications, narcotic and muscle relaxant doses, and speed of anesthetic drug administration may also influence hemodynamicresponses and may explain differing results reported by others using the same drug combinations.

Key Words: ANESTHETICS, INTRAVENOUS—fentanyl, sufentanil • NEUROMUSCULAR RELAXANTS—pancuronium, vecuronium

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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