Hemodynamic and Biochemical Comparison of the Use of Pancuronium and Vecuronium in Coronary Revascularization Operations Performed with the Beating Heart Method in Patients Using Perioperative Beta Blockers

Öz

The aim of this study was to investigate the effects of preoperative oral and intraoperative administration of metoprolol on hemodynamics and cardiac enzymes in patients using vecuronium or pancuronium as muscle relaxants during beating heart coronary artery bypass surgery. 23 patients were included in the study. In all patients, heart rate (HR), systolic and diastolic arterial pressure (SAP, DAP, respectively), central venous pressure (CVP), pulmonary arterial pressure (PAP), cardiac index (CI), stroke volume (SV), left ventricular stroke work index (LVSWI), right ventricular stroke work index (RVWWI), pulmonary vascular resistance (PVR), and systemic vascular resistance (SVR) were monitored in the perioperative period. Group V was the vecuronium group and group P was the pancuronium group. Metoprolol was administered orally preoperatively and intravenously before anastomosis. There was no significant difference between the two groups in SAB, DAB, CI, SVI, LVSWI, RVSWI, SVR, PVR in the same periods (p>0,05). HR, SAB, DAB, CI decreased at the beginning of anastomosis with metoprolol in both groups. The intraoperative total metoprolol doses were found to be lower in Group V (11.5± 6.3 mg) than in Group P (21.7±8.7) (p<0,01). Perioperative myocardial ischemia or arrhythmia did not occur in either group. Intraoperative intravenous administration of metoprolol in beating heart-CABG surgeries cresulted in similar hemodynamic changes in the groups of patients in whom vecuronium or pancuronium was used. However, the use of vecuronium appears to be more appropriate because of the lewer metoprolol requirements.

Anahtar Kelimeler

• beating heart
• cardiac surgery
• beta blockers
• vecuronium
• pancuronium

Perioperatif Beta Blokör Kullanılan Hastaların Beating Heart Yöntemi ile Yapılan Koroner Revaskülarizasyon Operasyonlarında Pankuronyum ve Vekuronyum Kullanımının Hemodinamik ve Biyokimyasal Olarak Karşılaştırılması

Öz

Bu çalışmada preoperatif oral yolla metoprolol alan, atan kalpte koroner arter bypass ameliyatları (Beating heart-CABG) sırasında kas gevşetici olarak vekuronyum veya pankuronyum kullanılan hastalarda, intraoperatif iv yolla metoprolol uygulanmasının, hemodinami ve kardiyak enzimler üzerine etkilerinin incelenmesi amaçlandı. Çalışmaya 23 hasta dahil edildi. Tüm hastalarda kalp hızı (HR), sistolik ve diyastolik arter basıncı (sırasıyla SAB, DAB), santral venöz basınç (CVP), pulmoner arter basıncı (PAB), kardiyak indeks (CI), atım volümü (SV), sol ventrikül atım iş indeksi (LVSWI), sağ ventrikül atım iş indeksi (RVSWİ), pulmoner vasküler rezistans (PVR), sistemik vasküler rezistans (SVR) perioperatif dönemde izlendi. Grup V vekuronyum, Grup P pankuronyum grubu idi. Preoperatif oral, anastomoz öncesi ise iv yolla metoprolol uygulandı. İki grup arasında SAB, DAB, CI, SVI, LVSWI, RVSWI, SVR, PVR ler arasında aynı dönemlerde anlamlı fark bulunmadı (p>0,05). Her iki grupta metoprolol ile anastomoz başlangıcında HR, SAB, DAB, CI azaldı. İntraoperatif toplam metoprolol dozları Grup V’ de (11.5± 6.3 mg), Grup P‘ye (21.7±8.7) göre düşük bulundu (p<0,01). İki grupta da periperatif miyokardiyal iskemi, aritmi gelişmedi. Beating heart-CABG ameliyatlarında intraoperatif iv yolla metoprolol uygulaması, vekuronyum veya pankuronyumun kullanıldığı hasta gruplarında benzer hemodinamik değişikliğe yol açmıştır. Ancak metoprolol gereksiniminin daha düşük olması nedeniyle vekuronyum kullanımı daha uygun görünmektedir.

Anahtar Kelimeler

• atan kalpte by pass
• kalp cerrahisi
• beta blokörler
• vekuronyum
• pankuronyum

Kaynakça

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