Vol 6, No 3 (2021)
Research paper
Published online: 2021-07-20

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Effect of rocuronium on the heart rate and arterial blood pressure during combined general anaesthesia

Urszula Kosciuczuk1, Paulina Gluszynska2, Inna Diemieszczyk2, Aleksander Lukaszewicz2, Krzysztof Bauer3, Maciej Kokoszko4, Lukasz Szarpak5, Jerzy Robert Ladny3, Hady Razak Hady2
Disaster Emerg Med J 2021;6(3):104-111.

Abstract

INTRODUCTION: Additional mechanisms of neuromuscular blocking agents action create the haemodynamic condition during general anaesthesia. The aim was to investigate the effect of rocuronium on haemodynamic parameters during combined general anaesthesia.  

MATERIAL AND METHODS: The study was conducted in two groups: Group I underwent combined anaesthesia with rocuronium and Group II — combined anaesthesia without any muscle relaxants. Haemodynamic parameters: heart rate, systolic, diastolic and mean arterial blood pressure were recorded before anaesthesia, at the end of rocuronium infusion, and after recovery from anaesthesia.  

RESULTS: In both groups, the values of the median heart rate, systolic, diastolic and mean arterial blood pressure recorded before and after anaesthesia were similar and did not differ significantly. In Group I, significant reduction in heart rate in the end of rocuronium infusion [74 (61–103)], (p = 0.01) and after recovery from anesthesia [71 (53–100)], (p = 0.03), compared to the value before anesthesia [81 (56–104)], were demonstrated. Additionally, significant reduction in systolic [130 (96–169); 114 (92–144)], (p = 0.04), diastolic [80 (54–109); 73 (47–99)], (p = 0.01), and mean [95 (72–106); 85 (68–109)], (p = 0.02) arterial blood pressure in the end of rocuronium infusion were noticed. The values of systolic, diastolic and mean blood pressure after recovery from anaesthesia significantly increased in relation to the values observed in the end of the rocuronium infusion [129 (96–181)], (p = 0.01); [78 (47–107)], (p = 0.03); [93 (63–107)], (p = 0.03).  

CONCLUSIONS: The vagolytic effect was not observed during general anaesthesia with rocuronium. The changes in heart rate and blood pressure were associated with the rocuronium infusion and were normalized after recovery from anaesthesia.

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References

  1. Stäuble CG, Blobner M. The future of neuromuscular blocking agents. Curr Opin Anaesthesiol. 2020; 33(4): 490–498.
  2. Smetana KS, Roe NA, Doepker BA, et al. Review of Continuous Infusion Neuromuscular Blocking Agents in the Adult Intensive Care Unit. Crit Care Nurs Q. 2017; 40(4): 323–343.
  3. Murphy GS. Neuromuscular Monitoring in the Perioperative Period. Anesth Analg. 2018; 126(2): 464–468.
  4. Shantsila A, Gupta D, Lip GYH. Heart rate variability changes following catheter ablation for atrial fibrillation. Kardiol Pol. 2020; 78(3): 179–180.
  5. Gunter A, Ruskin KJ. Intraoperative neurophysiologic monitoring: utility and anesthetic implications. Curr Opin Anaesthesiol. 2016; 29(5): 539–543.
  6. Schepens T, Cammu U. Neuromuscular blocade: what was, is and will be. Acta Anaesthesiol Belg. 2014; 4: 151–159.
  7. Blobner M, Frick CG, Stäuble RB, et al. Neuromuscular blockade improves surgical conditions (NISCO). Surg Endosc. 2015; 29(3): 627–636.
  8. Bartels K, Esper SA, Thiele RH. Blood Pressure Monitoring for the Anesthesiologist: A Practical Review. Anesth Analg. 2016; 122(6): 1866–1879.
  9. Maheshwari K, Khanna S, Bajracharya G, et al. A Randomized Trial of Continuous Noninvasive Blood Pressure Monitoring During Noncardiac Surgery. Anesthesia & Analgesia. 2018; 127(2): 424–431.
  10. Sokół-Kobielska E. Od kurary do esmeronu - czy to przepaść, czy tylko różnica? Anaesthesiol Intensive Ther. 2005; 2: 130–136.
  11. Kristensen SD, Knuuti J, Saraste A, et al. [2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment andmanagement]. Kardiol Pol. 2014; 72(11): 857–918.
  12. Krzych Ł, Kucewicz-Czech E. It is time for enhanced recovery after surgery in cardiac surgery. Kardiologia Polska. 2017; 75(5): 415–420.
  13. Gaszynski TM, Szewczyk T. Rocuronium for rapid sequence induction in morbidly obese patients: a prospective study for evaluation of intubation conditions after administration 1.2 mg kg⁻¹ ideal body weight of rocuronium. Eur J Anaesthesiol. 2011; 28(8): 609–610.
  14. Turan A, Chang C, Cohen B, et al. Incidence, Severity, and Detection of Blood Pressure Perturbations after Abdominal Surgery: A Prospective Blinded Observational Study. Anesthesiology. 2019; 130(4): 550–559.
  15. Pendeville PE, Lois F, Scholtes JL. A comparison of intubation conditions and time-course of action with rocuronium and mivacurium for day case anaesthesia. Eur J Anaesthesiol. 2007; 24(6): 546–550.
  16. Hemmerling TM, Russo G, Bracco D. Neuromuscular blockade in cardiac surgery: an update for clinicians. Ann Card Anaesth. 2008; 11(2): 80–90.
  17. Virmani S, Tempe DK, Datt V, et al. Effect of muscle relaxants on heart rate, arterial pressure, intubation conditions and onset of neuromuscular block in patients undergoing valve surgery. Ann Card Anaesth. 2006; 9(1): 37–43.
  18. Öztürk T, Ağdanli D, Bayturan Ö, et al. Effects of conventional vs high-dose rocuronium on the QTc interval during anesthesia induction and intubation in patients undergoing coronary artery surgery: a randomized, double-blind, parallel trial. Braz J Med Biol Res. 2015; 48(4): 370–376.
  19. Gursoy S, Bagcivan I, Durmus N, et al. Investigation of the cardiac effects of pancuronium, rocuronium, vecuronium, and mivacurium on the isolated rat atrium. Curr Ther Res Clin Exp. 2011; 72(5): 195–203.
  20. Castillo-Zamora C, Lespron Md, Nava-Ocampo AA. Similar preoperative hemodynamic response to pancuronium and rocuronium in high-risk cardiac surgical patients. Minerva Anestesiol. 2005; 71(12): 769–773.
  21. Bowman WC. Neuromuscular block. Br J Pharmacol. 2006; 147 Suppl 1: S277–S286.
  22. Mathew A, Sharma ANG, Ganapathi P, et al. Intraoperative hemodynamics with vecuronium bromide and rocuronium for maintenance under general anesthesia. Anesth Essays Res. 2016; 10(1): 59–64.
  23. Somani M, vyas S, Sharma P, et al. A Comparitive Study between Vecuronium and Rocuronium for Intubating Condition and Hemodynamic Changes. IOSR Journal of Dental and Medical Sciences. 2014; 13(6): 33–39.
  24. P A. A Comparative Study of Rocuronium and Succinylcholine for Rapid Sequence Induction of Anaesthesia. Journal of Medical Science And clinical Research. 2016; 04(10): 13317–13324.
  25. Kumar A, Saran J, Chandra R, et al. A COMPARATIVE CLINICAL EVALUATION OF INTUBATING CONDITIONS AND HAEMODYNAMIC EFFECTS AFTER ADMINISTRATION OF SUCCINYL CHOLINE & ROCURONIUM BROMIDE. Journal of Evolution of Medical and Dental Sciences. 2015; 4(28): 4769–4780.
  26. Wierda JM, Schuringa M, van den Broek L. Cardiovascular effects of an intubating dose of rocuronium 0.6 mg kg-1 in anaesthetized patients, paralysed with vecuronium. Br J Anaesth. 1997; 78(5): 586–587.
  27. Belekar VB, Khamankar S. Rocuronium for tracheal intubation in patients undergoing emergency surgery. Int J Pharmacol Res. 2013; 3: 18–22.
  28. Parasa M, Vemuri NN, Shaik MS. Comparison of equipotent doses of rocuronium and vecuronium. Anesth Essays Res. 2015; 9(1): 88–91.
  29. Hudson ME, Rothfield KP, Tullock WC, et al. Haemodynamic effects of rocuronium bromide in adult cardiac surgical patients. Can J Anaesth. 1998; 45(2): 139–143.
  30. Lee S, Lee J, Lee S, et al. The Effect of Nicorandil on the Pharmacodynamics of Rocuronium. Korean Journal of Anesthesiology. 2006; 50(5): 567.
  31. Schramm WM, Strasser K, Bartunek A, et al. Effects of rocuronium and vecuronium on intracranial pressure, mean arterial pressure and heart rate in neurosurgical patients. Br J Anaesth. 1996; 77(5): 607–611.
  32. Shorten GD, Uppington J, Comunale ME. Changes in plasma catecholamine concentrations and haemodynamic effects of rocuronium and vecuronium in elderly patients. Eur J Anaesthesiol. 1998; 15(3): 335–341.
  33. Stevens JB, Hecker RB, Talbot JC, et al. The haemodynamic effects of rocuronium and vecuronium are different under balanced anaesthesia. Acta Anaesthesiol Scand. 1997; 41(4): 502–505.