Comparison of the neuromuscular and cardiovascular effects of pipecuronium and panduronium

Chung, Nam Young; Han, Jong In; Kim, Chi Hyo; Lee, Choon Hi

Abstract

Pipecuronium bromide (Arduan) is a new steroid base, bisquatemary neuromuscular blocking agent in clinical use in Eastern Europe. The chemical structure, speed of onset and duration of neuromuscular effect of pipecuronium is similar to those of pancuronium. Unlike pancuronium, however, it has no unwanted cardiovascular effects. The neuromuscular and cardiovascular effects of pipecuronium were compared with those of pancuronium in 40 adult patients anesthetized with thiopentone, nitrous oxide with oxygen and intravenous meperidine nad diazepam. Twenty patients received pancuronium 0.02 mg/kg, followed 3 minutes later by pancuronium 0.1 mg/kg intravenously (pancuronium group). The other 20 patients received pipecuronium 0.015 mg/kg and 0.08 mg/kg (pipecuronium gmup). Patient's complaint was asked 2 minutes after administrations af the priming doses. Times to 75% and 100% twitch depression were measured and the conditions of tracheal intubation were evaluated at 100% twitch depression. Heart rate, and systolic and diastolic blood pressures were checked noninvasively on arrival in the operating room (control), before trachal intubation (maximal relaxation), 1, 3, and 5 minutes after tracheal intubation. The results obtained were as follows; 1) Mild complaint of patient, such as unable to open eyes or blurred vision after priming doses was 95% in the pancuronium group and 75% in the pipecuonium group. 2) The times to 75% and 100% twitch depression of the pipecuronium group were 72+/-2.2 sec and 112.8+/-3.3 sec and were shorter than those of the pancuronium group. 3) In the pancuronium group, there was significant increases of heart rate and rate pressure product (RPP) before tracheal intubation, 1, 3, and 5 minutes after tracheal intubation compared with control value. In the pipecuronium group, there was no significant change in heart rate before tracheal intubation and 5 min after tracheal intubation compared with control value, but significant decrease in blood pressure, occured with decrease in RPP. The heart rate and RPP following administration of pipecuronium decreased significantly before tracheal intubation and 5 min after tracheal intubation compared with the pancuronium group. The results from the above study suggest that pipecuronium would have advantages over patients with significant cardiovascular diseases for a prolonged operation.