Journal of cardiothoracic anesthesia
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J Cardiothorac Anesth · Apr 1988
Clinical TrialA method of rapid-sequence induction using high-dose narcotics with vecuronium or vecuronium and pancuronium in patients with coronary artery disease.
A method of rapid-sequence induction was studied in 18 patients undergoing coronary artery bypass grafting (CABG) to assess the adequacy of relaxation for endotracheal intubation without resulting in major changes in heart rate (HR). Ten patients received vercuronium, 0.2 mg/kg (V); and eight patients received vecuronium, 0.1 mg/kg, and pancuronium, 0.1 mg/kg (V + P). All patients then received fentanyl, 50 to 70 microg/kg, or sufentanil, 5 to 7 microg/kg, followed 60 seconds later by intubation. ⋯ All patients were intubated without difficulty. The mean change in HR was -4.1 beats/min for patients receiving V and +16.4 beats/min for those receiving V + P (P < .002 for change in HR), with two V + P patients developing tachycardia. It is concluded that the onset of neuromuscular blockade is more rapid in the distribution of the mandibular nerve than at the ulnar nerve; mandibular nerve stimulation is a better predictor of adequate intubating conditions; good intubating conditions can be attained with either V or V + P; and, rapid-sequence induction with V is safe from a cardiac standpoint as measured by changes in HR, but the addition of pancuronium is unnecessary.