Pancuronium, Vecuronium and Atracurium in the Treatment of Shivering After Cardiac Surgery

This randomized study compared the hemodynamic and metabolic effects of pancuronium, vecuronium and atracurium during treatment of shivering after cardiac surgery with hypothermic cardiopulmonary bypass. 60 patients were evaluated in three groups and were treated with pancuronium (Group I, n=20) 0.08 mg/kg, vecuronium (Group II, n=20) 0.08 mg/kg and atracurium (Group III, n=20) 0.8 mg/kg. Values of heart rate, mean arterial pressure, arterial and venous blood gases, total body oxygen consumption (VO2-I) and pressure-work index (PWI) were measured. Continuous ST segment analysis was used to detect myocardial ischemia. Treatment of shivering with pancuronium decreased VO2-I by 27% and heart rate was increased by 19%. Vecuronium decreased VO2-I by 34% with an increase 5% in heart rate. Atracurium desreased VO2-I41% with no change in heart rate. Myocardial ischemia occurred in 4 patients treated with pancuronium. Ventricular arrhythmias occurred in four patients treated with vecuronium. Only one patient treated with vecuronium had ventricular arrhythmia. Patients treated with pancuronium, vecoronium and atracurium were taking beta-adrenergic blockers preoperatively which was associated with lower PWI at onset of shivering. We concluded that, compared with the other two drugs, atracurium is the best choice during treatment of shivering because of lower hemodynamic and metabolic complications and no increase in PWI.