Incidence of intra‐operative bradycardiaComparison of atracurium and vecuronium in gynaecological surgery

Abstract

SummaryEighty patients undergoing lower third molar surgery under general anaesthesia were assigned to one of two groups to receive local anaesthetic blockade either 10 min prior to surgery or after surgery just before leaving the operating theatre. Patients in both groups received the local anaesthetic block whilst unconscious. Pain was assessed using visual analogue scales at 6 h and 1, 3 and 6 days after surgery. A McGill Pain Questionnaire was also completed on the morning following surgery. At no time was it possible to detect any significant difference in pain between the two groups. The administration of local anaesthesia prior to starting surgery does not appear to have any advantage over its postoperative administration in patients undergoing this type of surgery. The local anaesthetic, however, does provide excellent analgesia during the first few hours following surgery. The treatment of postoperative pain by intermittent doses of analgesic, on an 'as-required' basis, is often ineffective [1, 2]. A renewed interest in improving postoperative analgesia has taken place since the publication of a document by the Working Party on Pain After Surgery, highlighting the inadequacy of postoperative analgesia [1] and the possibility of improving this situation by providing analgesia prior to tissue injury [2]. The latter hypothesis was proposed in an editorial by Wall and was based on research which showed that blocking nociceptive stimuli from reaching the central nervous system (CNS) prevented hyperexcitability within the spinal cord [3][4][5].Animal and clinical work has illustrated the benefit of treating surgical pain by blocking nociception prior to surgery -pre-emptive analgesia [3, 6 ,7]. In theory, central sensitisation could be prevented if nociceptive information was prevented from arriving at the CNS by neuronal blockade or by the use of drugs like opioids to minimise this sensitisation [6]. We chose to study the former method, since it should result in the prevention of nociceptive information reaching the CNS during surgery and thus prevent the initiation of central sensitisation. MethodsEighty ASA grade 1 and 2 patients, who were to undergo lower third molar extraction under general anaesthesia, were enrolled into the study. The study had been granted Ethics Research Committee approval by the Queen's University of Belfast and written informed consent was obtained from each patient. Prior to surgery, each patient was given a pain questionnaire and advised on how to complete it during the week following surgery. Pain assessment was carried out using 100-mm vertical visual analogue scales for pain (VAS; 0 ¼ no pain; 100 ¼ worst pain possible) at 6 h or just after the local anaesthetic ceased to act. Assessments using VAS were also carried out on the morning following surgery, as well as on the mornings of the third and sixth days. A long form McGill Pain Questionnaire was also completed on the morning following surgery. ᮊ 1997 Blackwell Science LtdThe patients were randomly assigned to one of two ...

Bradycardia During Laparoscopic Surgeries: A Retrospective Cohort Study

“…The majority of bradycardia events were related to CO 2 insufflation and traction on pelvic structures and spontaneously resolve without the need for pharmacological treatment [9]. Following studies found similar results in limited number of healthy (ASA I–II) patients [2, 3, 6, 7, 10, 11]. The frequency of bradycardia in the present study was 15.5%, much lower than previously described (20–30%) [2, 3, 9].…”

“…During laparoscopic surgery, this may happen during peritoneal stretching with gas insufflation, in particular during light anesthesia which can also induce bradycardia during laryngoscopy [4, 9]. Except for the effect of muscle relaxant on the occurrence of bradycardia [6, 7], other events triggering bradycardia were not investigated and risk factors were reported only in a paucity of studies [8]. Thus, using the computerized medical and anesthesia record database in the Tel Aviv Medical Center, we undertook this study to identify in a large cohort of patients undergoing laparoscopic surgery, the frequency of bradycardia in a variety of surgical procedures, possible underlying triggers, patient’s characteristics predisposing to bradycardia, the frequency and type of intervention taken to treat this happening and perioperative outcome.…”

“…Bradycardia is common during laparoscopy [1][2][3][4][5][6][7][8][9][10][11]. With bradycardia defined as heart rate\50 or 60 beats/min, without remark regarding the duration of the event, the reported incidence during laparoscopy was 15-56% [2,3,9].…”

Perioperative management of hereditary arrhythmogenic syndromes

“…63 66 74 75 Vecuronium has been associated with a higher incidence of severe (,40 beats min 21 ) and symptomatic bradycardia than atracurium. 86 A comparison of vecuronium and rocuronium showed that profound bradycardia occurred in the vecuronium group only and that 5% of the vecuronium group patients had periods of transient asystole. 87 This suggests that neuromuscular blocking agents with vagolytic properties, such as rocuronium, should be used in patients with SSS.…”

Severe bradycardia caused by the deviation of the laryngeal mask airway Supreme

“…It is well recognized that vecuronium induces bradycardia because of its direct action or the increase in vagal tone induced by surgical procedures. [25,26] However, Cisatracurium, the one we used nondepolarizing muscle relaxant in this case, does not induce significant cardiac effects. [27] Other drugs may cause bradycardia, either alone or in combination with others, such as the β- blockers, Digitalis and NDHP-CCBs but which this patient had not received.…”