DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162269

Assessment of haemodynamic stability with intubating dose of intravenous rocuronium bromide versus vecuronium bromide in predominantly stenotic valvular cardiac surgery patients

Priyanka Bhagade, Dhawal Wadaskar, Bharati Tendolkar

Abstract


Background: In the purely or predominantly mitral stenotic heart surgeries, the principal haemodynamic goals are to maintain a sinus rhythm and avoiding tachycardia. Thus rapid airway control and hemodynamic stability are vital for successful anaesthetic management of patients undergoing the cardiac surgeries. In such patients, muscle relaxants play a pivotal role for achieving good hemodynamic stability. Hence, this study was conducted to evaluate the hemodynamic stability of rocuronium bromide i.v. vecuronium bromide.

Methods: The study conducted was randomized prospective double blind study in 60 adult patients (30 in each group) undergoing elective cardiac valvular surgery. Each group received either intubating dose of Rocuronium (0.6 mg/kg body weight) or intubating dose vecuronium (0.1 mg/kg body weight) intravenously after receiving sedation and analgesia. Hemodynamic parameters like heart rate, systolic and diastolic blood pressure, mean arterial pressure and central venous pressure were recorded at baseline 10 minutes after sedation /analgesia at induction, laryngoscopy and at  intubation. Any side effects during intubation were noted.

Results: Intubating doses of either Rocuronium or vecuronium are not associated with any haemodynamic adverse effects. Also there were no statistically significant (p<0.05) differences between both these groups, in any of the variables at any time.

Conclusions: The present study showed that Rocuronium had maintained excellent cardiovascular stability for the dose given to the patient. There was no statistically significant increase in heart rate, systolic, diastolic and mean arterial blood pressure after administration of Rocuronium as compared to vecuronium in the study.

 


Keywords


Hemodynamic changes, Mitral stenotic heart surgeries, Rocuronium, Vecuronium, Intubation

Full Text:

PDF

References


Park K. Non communicable diseases. 22nd Ed. 2013;349-51.

Nancy A, Nussmeier. Anaesthesia for cardiac surgical procedure. Miller’s Anaesthesia, 7th Ed. 2010;1927-36

Makhija N, Saxena N, Usha Kiran, Choudhury M. Haemodynamic effects and Intubating conditions following Rocuronium and its combination with Vecuronium or Pancuronium in elective paediatric cardiac pts. IJA. 2006;50(4):295-9.

Kale S, Kane D, Dewoolkar L, Pandya S. Comparison of haemodynamic stability with intubating dose of Rocuronium Vs Intubating Dose of Vecuronium in cardiac Surgery pts KEM hosp Mumbai. IJA. 2007;12(1):1-6.

Morris RB, Cahalan MK, Miller RD, Wilkinson PL, Quasha AL, Robinson SL. The cardiovascular effects of Vecuronium and Pancuronium in patients undergoing coronary artery bypass grafting. Anesthesiology. 1983;58:438-40.

Salmenpera M, Peltolak, Takkunen O, Heinomen J: Cardiovascular effects of Pancuronium and Vecuronium during high dose fentanyl anaesthesia. Anaesthesia analgesia.1983;62:1059-64.

Milligan KR, Beers HT. Vecuronium associated cardiac arrest (Letter). Anaethesia. 1985;40:385.

Wierda JMKH, De Wit APM, Kuizenga K, Agoston S. Clinical observations on the neuromuscular blocking agent. Br J Anaesth. 1990;64:521-3.

Muir AW, Houston J, Green KL, Marshall RJ, Bowman WC, Marshall IG. Effects of a new neuromuscular blocking agent (Org 9426) in anaesthetised cats and pigs and in isolated nerve muscle preparation. Br J Anaesthesia. 1989;63:400-10.

McCoy EP, Maddineni VR, Elliott P, Mirakhur RK, Carson IW, Cooper RA. Haemodynamic effects of rocuronium during fentanyl anaesthesia: comparison with vecuronium. Can J Anaesth. 1993;40:703-8.

Levy JH, Davis GK, Duggan J, Szlam,F. Determination of the hemodynamics and histamine release of rocuronium (Org 9426) when administered in increased doses under N2O/O2 sufentanil anaesthesia. Anesth Analg. 1994;78:318-21.

Nitschmann P, Oberkogler W, Hertsig M, Schwarz S. Comparison of hemodynamic effects of rocuronium bromide with those of recuronium in patients undergoing CABG surgery. Eur J. Anaesth. 1994;11(9):113-5.

Cornet JP, Abiad M, Coriat P. Evaluation of the effects of rocuronium bromide on haemodynamics and left ventrivular function in patients undergoing abdominal aortic surgery. E. J. of Anaesth. 1994;11:78-81.

Girish Babu N, Chaturvedi S. Comparison of intubating conditions and haemodynamic effects of Rocuronium and Mixture of Vecuronium and Rocuronium in pts undergoing elective coronary bypass graft surgery. Int J.Pharm Biomed Res. 2011;2(3):182-7.

Virmani S, Tempe DK, Vishnu Datt DA, Tomar AS, Banerjee A, Harpreet Singh M, et al. Effect of muscle relaxant on heart rate, arterial pressure, intubating conditions and onset of neuromuscular block in patients undergoing valve surgery. ACA. 2006;9:37-43.

Robertson EN, Hull JM, Verbeek AM, Booij LHDJ. A comparison of rocuronium and vecuronium. The pharmacodynamic, cardiovascular and intraocular effects. Eur J. Anaesth. 1994;11(9):116-21.