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Comparative Evaluation of the Neuromuscular and Cardiovascular Effects of Pipecuronium, Pancuronium, Atracurium, and Vecuronium Under Isoflurane Anesthesia

The neuromuscular and cardiovascular effects of intubating doses of pipecuronium 80 μg/kg, pancuronium 100 μg/kg, atracurium 500 μg/kg, and vecuronium 100 μg/kg were compared in 62 patients under isoflurane (end‐tidal concentration = 0.5–1%) anesthesia. Pipecuronium, pancuronium, and vecuronium had no significant effect on systolic or diastolic blood pressure. In one patient the administration of atracurium resulted in significant hypotension. Heart rate was significantly increased only after the administration of pancuronium. The neuromuscular‐blocking effect of pipecuronium and pancuronium appears to be twice as long as that of vecuronium and atracurium. Administration of neostigmine resulted in significantly faster recovery of muscle function in patients receiving vecuronium or atracurium. Although pipecuronium's neuromuscular‐blocking effect is similar to that of pancuronium, its lack of cardiovascular effects more closely resembles that of vecuronium.