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Elderly coronary artery bypass graft patients with left ventricular dysfunction are hemodynamically stable after two
Insights
Rocuronium (2x to 3x the effective dose 95%) provides cardiovascular stability in elderly patients undergoing coronary artery bypass grafting (CABG) with left ventricular dysfunction. Both doses showed similar hemodynamic profiles, indicating suitability for muscle relaxation in high-risk patients.
Area of Science:
- Anesthesiology
- Cardiovascular Physiology
- Pharmacology
Background:
- Elderly patients with left ventricular dysfunction undergoing coronary artery bypass grafting (CABG) present unique anesthetic challenges.
- Rocuronium is a commonly used neuromuscular blocking agent, but its hemodynamic effects in this specific patient population require clarification.
Purpose of the Study:
- To evaluate the detailed hemodynamic responses to two different bolus doses of rocuronium (2x and 3x the 95% effective dose [ED95]) in elderly patients with left ventricular dysfunction undergoing elective CABG.
- To compare the cardiovascular stability provided by these two rocuronium doses.
Main Methods:
- Prospective, randomized clinical study conducted at a university hospital.
- Twenty elderly patients (age > 65) with coronary artery disease and left ventricular ejection fractions ≤ 40% were included.
- Invasive cardiac monitoring was used to obtain detailed hemodynamic profiles before and at 2, 4, 6, 8, and 10 minutes after rocuronium injection.
Main Results:
- Minor changes in measured hemodynamic variables were observed within both groups but did not reach statistical significance.
- No statistically or clinically significant differences in hemodynamic variables were found between the 2x ED95 and 3x ED95 rocuronium groups at any time point.
- One group exhibited higher baseline and subsequent mean arterial pressures.
Conclusions:
- Bolus administration of rocuronium (2x to 3x ED95) combined with high-dose fentanyl ensures adequate cardiovascular stability in elderly CABG patients with left ventricular dysfunction.
- The hemodynamic profiles of the two tested rocuronium doses were similar.
- Rocuronium, at both evaluated doses, is a suitable muscle relaxant for patients requiring significant cardiovascular stability during surgery.
Objective:
To clarify the detailed hemodynamic responses to bolus administration of 2x 95% effective dose (ED95) and 3x ED95 of rocuronium in elderly patients with left ventricular dysfunction undergoing elective coronary artery bypass grafting (CABG).
Design:
Prospective, randomized, clinical study.
Setting:
University hospital.
Participants:
Twenty patients aged older than 65 who had coronary artery disease with left ventricular ejection fractions equal to or less than 40%.
Interventions:
Using invasive cardiac monitoring, the detailed hemodynamic profile was obtained before and at 2, 4, 6, 8, and 10 minutes after the injection of rocuronium.
Measurements And Main Results:
Minor changes in all the measured or derived hemodynamic variables within the two groups did not attain statistical significance. Except for a higher baseline and the subsequent mean arterial pressures in one group, there were neither statistically nor clinically significant differences between two different doses of rocuronium in any of the variables at any time.
Conclusion:
The results demonstrate that bolus administration of rocuronium (2x to 3x ED95) in combination with high-dose fentanyl provides sufficient cardiovascular stability among elderly CABG patients with left ventricular dysfunction. The cardiovascular profile of the two different bolus doses was similar. Rocuronium, in both doses, appears to be a suitable agent for muscle relaxation, especially for patients who require a high degree of cardiovascular stability.