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Cardiac Electrophysiologic Effects of Pancuronium

Received from the Departments of Surgery and Physiology, Loyola University, Stritch School of Medicine, Maywood, Illinois and Research Service, Hines VA Hospital, Hines, Illinois; the Department of Anesthesiology, Northwest Hospital, Chicago, Illinois; the Department of Anesthesiology, Illinois Masonic Hospital, Chicago, Illinois; the Department of Anesthesiology, Loyola University, Maywood, Illinois; the Department of Critical Care Medicine, Memorial Medical Center of Jacksonville, Jacksonville, Florida; and the Department of Cardiothoracic Surgery, Aultman Hospital, Canton, Ohio.

Abstract

A microelectrode examination of guinea pig left ventricular papillary muscle was performed to determine whether there was a direct effect of pancuronium on cardiac cells and, if so, to attempt to ascertain the mechanism of this effect. Electrical events were measured before and during superfusion with pancuronium, epinephrine, propranolol, and verapamil; alone and in various combinations. Pancuronium prolonged the duration of the action potential (AP); increased resting potential (Em), AP magnitude, and rate of rise of the AP (dV/dt); and resulted in spontaneity in 12% of the muscles. Epinephrine and pancuronium combined caused spontaneity in 80% of the muscles and oscillatory behavior. Additionally, this combination decreased AP magnitude, Em, and dV/dt in several preparations—a pattern of response similar to that seen in ouabain-treated myocardial cells under the influence of catecholamines. These changes were always reversed by verapamil or by perfusion with a drug-free medium, and were usually reversed by propranolol. The data suggest a combined pancuronium/epinephrine induced increase in cardiac membrane permeability to Ca²⁺.

Key Words: NEUROMUSCULAR RELAXANTS—pancuronium • HEART—pancuronium effects

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999