Alfentanil combined with vecuronium or pancuronium: haemodynamic implications

Abstract

Forty-two fit, anticholinergized patients, induced with thiopentone, received either vecuronium (V) or pancuronium (P) 0.1 mg/kg, followed by alfentanil 15 micrograms/kg. The mean heart rate in the Group V was significantly lower than that in the Group P. The difference, 10-15 bpm, appeared after alfentanil administration, and lasted for 5 min postintubation, when under N2O anaesthesia. The Group P patients maintained their arterial pressure closer to the preinduction level than did the Group V patients, but a statistically significant inter-group difference appeared only at two recording stages. Four Group V patients, contrasted to none of the Group P patients (P less than 0.05), were put in head-down tilt, or were given atropine, and/or etilephrine for an undue decrease in arterial pressure. Compared to vecuronium, pancuronium increased heart rate, and protected from arterial hypotension, when combined with low-dose alfentanil.

Haemodynamic effects of high‐dose vecuronium compared with pancuronium in beta‐blocked patients with coronary artery disease during fentanyl‐diazepam‐nitrous oxide anaesthesia

“…The vagolytic (18) and sympaticomimetic effects (19) of pancuronium are well known. Pancuronium may thus counteract untoward circulatory effects of an opioid, preventing a narcotic-induced bradycardia from becoming manifest (20,21). In fact, the tachycardic effect of pancuronium may override the bradycardic effect from even high doses of fentanyl and, thereby, cause myocardial ischaemic episodes, as shown by Thomson & Putnins (2).…”