Evaluation of the effects of mivacurium chloride on hemodynamics and left ventricular function in patients with coronary artery disease undergoing abdominal aortic surgery

Objective: To determine the effects of two doses of mivacurium chloride on hemodynamics and left ventricular function in patients with documented coronary artery disease undergoing aortic surgery. Design: A prospective study with the dose of mivacurium determined by randomization. Setting: Induction area at a university hospital. Participants: Twenty consecutive patients undergoing aortic surgery with clinically and/or angiographically documented coronary artery disease. Interventions: Intravenous administration of mivacurium chloride. Measurements and Main Results: Induction of anesthesia was performed with midazolam and fentanyl. Two different doses of mivacurium chloride, 0.15 mg/kg (n = 10) and 0.2 mg/kg (n = 10; 2 and 2.5 ED95, respectively), were administered as a single bolus injection over a 60-second period in the absence of any surgical stimulation. In addition to standard hemodynamic monitoring, pulmonary artery catherization and transesophageal echocardiography were used. The occurrence of myocardial ischemia was monitored using both a computerized three-lead ST-segment analysis system and the echocardiographic assessment of regional wall motion. No change in heart rate, mean arterial pressure, pulmonary capillary wedge pressure, cardiac output, and global left ventricular function was noted after administration of mivacurium with the two doses studied. No ST-segment change or new segmental wall motion abnormality was noted in either group. Conclusion: Mivacurium chloride, when injected over a 60-second period, preserves global and regional myocardial function in patients with documented coronary artery disease undergoing noncardiac surgery.