Neidhart P P, Champion P, Vogel J, Zsigmond E K, Tassonyi E
Department of Anaesthesiology, University Hospital of Geneva, Switzerland.
Can J Anaesth. 1994 Jun;41(6):469-74. doi: 10.1007/BF03011539.
Pipecuronium bromide, a new neuromuscular relaxant with steroidal structure, is devoid of effects on the autonomic nervous system and may be useful in patients where haemodynamic stability is mandatory. However, tracheal intubation may alter this haemodynamic profile. Therefore, we carried out a prospective double-blind study in 30 patients undergoing coronary artery bypass surgery with the purpose (1) of determining if intubation influenced the haemodynamic stability in patients paralyzed with pipecuronium and (2) of comparing plasma catecholamine concentrations after pipecuronium with those after pancuronium. Thirty patients were randomized into two groups receiving either pipecuronium 100 micrograms.kg-1 or pancuronium 150 micrograms.kg-1 after induction of anaesthesia with midazolam and fentanyl. Haemodynamic variables and plasma catecholamines were measured before and after induction, after the muscle relaxant three times and twice after intubation. After anaesthesia induction decreases in heart rate (HR), mean arterial pressure (MAP) and cardiac index (CI) were observed in both groups. These haemodynamic variables were unchanged after pipecuronium whereas after pancuronium HR increased from 53 +/- 11 b.min-1 to 64 +/- 9 b.min-1 after induction (P < 0.05) and CI from 2.5 +/- 0.5 L.min-1 to 3.0 +/- 0.8 L.min-1 (P < 0.05). Furthermore ECG signs of myocardial ischaemia appeared in four patients after pancuronium and the decay of plasma norepinephrine concentration was slower than with pipecuronium. We conclude that pipecuronium given after induction of anaesthesia is free of sympathomimetic or vagolytic activity and does not influence haemodynamic variables for up to ten minutes after tracheal intubation.
哌库溴铵是一种具有甾体结构的新型神经肌肉阻滞剂，对自主神经系统无影响，可能适用于必须维持血流动力学稳定的患者。然而，气管插管可能会改变这种血流动力学状况。因此，我们对30例接受冠状动脉搭桥手术的患者进行了一项前瞻性双盲研究，目的是：（1）确定插管是否会影响使用哌库溴铵麻痹的患者的血流动力学稳定性；（2）比较哌库溴铵和泮库溴铵给药后血浆儿茶酚胺浓度。30例患者随机分为两组，在咪达唑仑和芬太尼诱导麻醉后，分别接受100微克/千克的哌库溴铵或150微克/千克的泮库溴铵。在诱导前、诱导后、肌肉松弛剂给药后三次以及插管后两次测量血流动力学变量和血浆儿茶酚胺。麻醉诱导后，两组患者的心率（HR）、平均动脉压（MAP）和心脏指数（CI）均下降。使用哌库溴铵后，这些血流动力学变量未发生变化，而使用泮库溴铵后，诱导后HR从53±11次/分钟增加到64±9次/分钟（P<0.05），CI从2.5±0.5升/分钟增加到3.0±0.8升/分钟（P<0.05）。此外，泮库溴铵给药后有4例患者出现心肌缺血的心电图征象，血浆去甲肾上腺素浓度的下降比哌库溴铵给药后慢。我们得出结论，麻醉诱导后给予哌库溴铵无拟交感神经或抗迷走神经活性，气管插管后长达10分钟内不影响血流动力学变量。
