CARDIOVASCULAR EFFECTS OF NEUROMUSCULAR BLOCKAGE WITH PANCURONIUM, VECURONIUM, AND ATRACURIUM IN NEONATES

Introduction: The purpose of this pilot study was to investigate the cardiovascular effects of pancuronium (PAN), vecuronium (VEC) and atracurium (ATR).Hypothesis: ATR and VEC are not as potent in cardiovascular side effects, especially blood pressure (BP).Methods: The Study was approved by the hospital's research advisory group. Infants (n=23) were randomized to receive either PAN 0.1 mg/kg, VEC 0.1 mg/kg or ATR 0.3 mg/kg prior to anaesthesia. The induction and maintenance procedures were standardized for all infants. The study drug was administered three minutes after induction in a double-blind fashion. A blinded observer recorded heart rate (HR) and blood pressure (BP) prior to induction, prior to study drug, and every 1 min for 5 min; then every 5 min for a total of 30 min. Statistics were by paired t-test and ANOVA. A p<0.05 was considered significant.Results: The groups were comparable in age, post conceptual age, weight and electrolytes. PAN caused an increase over baseline in AR at 5 min (p<0.05) and a decrease in BP at 2 min (p=<0.01) which persisted till 10 min (p=0.01). For ATR, there were no significant changes.Conclusions: This pilot study confirms that PAN causes an increase in HR and a decrease in BP in neonates. VEC may also cause a decrease in BP but ATR does not seem to affect either of these parameters. This suggests that for hemodynamic stability, ATR may be a better choice as a paralytic agent in newborns.