Atracurium versus vecuronium in asthmatic patients : a blinded, randomized comparison of adverse events

• Published in: Anesthesiology (Philadelphia) 1995-11, Vol.83 (5), p.986-991
• Main Authors: CALDWELL, J. E, LAU, M, FISHER, D. M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia, General; Anesthetics. Neuromuscular blocking agents; Asthma - physiopathology; Atracurium - adverse effects; Biological and medical sciences; Female; Fentanyl; Hemodynamics - drug effects; Humans; Male; Medical sciences; Midazolam; Middle Aged; Neuromuscular Nondepolarizing Agents - adverse effects; Neuropharmacology; Pharmacology. Drug treatments; Prospective Studies; Respiration - drug effects; Single-Blind Method; Vecuronium Bromide - adverse effects
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/00000542-199511000-00012

To determine which of atracurium or vecuronium is associated with fewer adverse cardiovascular and pulmonary events in high-risk patients, the authors administered these drugs to patients with known asthma. Sixty patients aged 18-75 yr taking bronchodilators chronically for asthma were anesthetized with midazolam, fentanyl, nitrous oxide, and isoflurane; the trachea was intubated without paralysis. When anesthetic conditions and mechanical ventilation were stable, patients were randomly given 0.5 mg/kg atracurium or 0.1 mg/kg vecuronium over 5-10 s, and a blinded observer recorded cardiovascular, pulmonary, and cutaneous signs of adverse reactions for 6 min. Arterial pressures and heart rate decreased after atracurium, and systolic pressure and heart rate decreased with vecuronium; these changes were small in magnitude. Cardiovascular effects (decrease in blood pressure or change in heart rate) > 10% were common with both atracurium (60% of patients) and vecuronium (57%). Cardiovascular effects > 20% were more frequent with atracurium (37%) than with vecuronium (13%, P < 0.05). The incidence of noncardiovascular adverse events (increase in peak airway pressure > 5 cmH2O, tidal volume decrease > 10%, rashes, and wheezing) did not differ between atracurium (17%) and vecuronium (7%). The largest increase in peak airway pressure was 5.1 cmH2O in a patient whose tidal volume decreased 16% with vecuronium; in the remaining patients, tidal volume decreased < 10%. No patients experienced inspiratory wheezing, marked decreases in arterial oxygen saturation, or marked increases in end-tidal carbon dioxide tension. The authors conclude that, in patients with asthma, adverse cardiovascular events are more common with atracurium than with vecuronium.