Ventilatory Compliance after Three Sufentanil–Pancuronium Induction Sequences

Publisher Website
Google Scholar
Abstract
Poor ventilatory compliance, a predictable side effect of high-dose opioid induction techniques, is purportedly blunted by pretreatment with nondepolarizing muscle relaxant. This study used both total compliance and a subjective compliance score to compare three different sequences of opioid induction using a 2-min infusion of sufentanil 3 μg·kg-1. Nineteen patients in each of three groups received a total of 100 μg·kg-1 of pancuronium, in the following randomized double-blinded fashion: control, all pancuronium 1 min after sufentanil; pretreated, 1 mg pancuronium 1 min before sufentanil and the balance of pancuronium 1 min after sufentanil; and mixed, all pancuronium mixed with sufentanil. Topical lidocaine prior to induction permitted early oral airway insertion midway through the sufentanil infusion. Immediately at the conclusion of sufentanil infusion, a tightly fitted mask, anterior jaw thrust, and mechanical ventilator permitted measurement of plateau airway pressure and exhaled volume in five replicates. Pressure and volume measurements were repeated 5 min later. Total compliance was calculated as the median plateau airway pressure divided into its associated exhaled volume. Groups did not differ in demographics. In one control patient and two pretreated patients hemoglobin oxygen saturation as measured by pulse oximetry decreased below 90%. Immediately after sufentanil infusion, the total compliance for control patients of 4.1 ml·cmH2O-1 (mean [2.6–6.5, 95% confidence interval]) did not differ from that of the pretreated group (6.3 [3.5–11.4] ml·cmH2O-1), but the mixed group exhibited higher compliance (40.3 [33.8–47.9] ml·cmH2O-1) than the other groups (P < 10-8). All groups achieved similar total compliances several minutes after a total of 100 μg·kg-1 pancuronium had been administered. Subjective compliance scores (0, 1, 2, or 3) agreed with objective data in all comparisons. Pretreatment with pancuronium did not effectively prevent the difficulty in ventilation associated with anesthesia induction using moderate-dose sufentanil. However, concomitant infusion of sufentanil and pancuronium substantially improved compliance, measured both subjectively and objectively, without causing early paralysis in suitably premedicated patients.

This publication has 0 references indexed in Scilit: