Adverse Effects of Pancuronium during High-dose Fentanyl Anesthesia for Coronary Artery Bypass Grafting

Publisher Website
Google Scholar
Abstract
Using a randomized double-blind protocol, 3 nondepolarizing muscle relaxants were compared with respect to their influence on hemodynamics and on the electrocardiogram. Patients (33) undergoing elective coronary artery bypass grafting (CABG) with high-dose (100 .mu.g/kg) fentanyl anesthesia were studied. Patients received 1.5 .times. ED95 of either pancuronium (n = 12), metocurine (n = 9), or a metocurine-pancuronium combination (4:1 ratio by wt.) (n = 12) for muscle relaxation. Heart rate and rate pressure product (RPP) were significantly high postinduction in the pancuronium group. Myocardial ischemia, indicated by ECG ST-segment depression occurred significantly more frequently, and exclusively, in the pancuronium group. Since pancuronium is associated with tachycardia and an increased incidence of myocardial ischemia, it is best avoided in patients with severe coronary artery disease undergoing CABG with high-dose fentanyl. Either metocurine or the metocurine-pancuronium is associated with tachycardia and an increased incidence of myocardial ischemia, it is best avoided in patients with severe coronary artery disease undergoing CABG with high-dose fentanyl. Either metocurine or the metocurine-pancuronium combination provides greater hemodynamic stability, without precipitating myocardial ischemia, and can be safely and effectively substituted for pancuronium.