Comparison of the cardiovascular effects of cisatracurium and vecuronium in patients with coronary artery disease

Abstract

Purpose: Cisatracurium besylate (Nimbex® Injection, Glaxo Wellcome Inc., Research Triangle Park, NC) is an intermediate-acting bis- benzylisoquinolinium neuromuscular blocking drug that is one of the stereoisomers of atracurium. At doses ≤ 8 x ED95, it caused no clinically important cardiovascular side effects or histamine release in healthy patients. The purpose of the present study was to investigate the haemodynamic effects of high doses of cisatracurium in patients with coronary artery disease. Methods: One hundred patients undergoing myocardial revascularization participated in a pilot study (seven patients) and a double-blinded, randomized, controlled trial comparing the haemodynamic effects of cisatracurium with vecuronium at three centres. The patients were anaesthetized using oxygen 100%, with etomidate, fentanyl and a benzodiazepine, and tracheal intubation was facilitated using succinylcholine. After baseline haemodynamic measurements, the study drug was administered over 5-10 sec according to group assignment: Group A (pilot) cisatracurium, 0.20 mg·kg-1 (4 x ED95), (n = 7); Group B-cisatracurium, 0.30 mg·kg-1 (6 x ED95), (n = 31); Group C-vecuronium, 0.30 mg·kg-1 (6 x ED95), (n = 31); Group D cisatracurium, 0.40 mg·kg-1 (8 x ED95), (n = 21); Group E-vecuronium, 0.30 mg·kg-1 (6 x ED95), (n = 10). The haemodynamic measurements were repeated at 2, 5, and 10 min after cisatracurium or vecuronium. Results: Two patients in Group D had >20% decreases in MAP, but only one required therapy for hypotension. The haemodynamic changes from pre- to post-injection in the cisatracurium patients were minimal and similar to patients receiving vecuronium. Conclusions: In patients with coronary artery disease, rapid cisatracurium (4-8xED95) boluses and vecuronium (6xED95) result in minor, clinically insignificant haemodynamic side effects.