pancuronium and Abnormalities--Multiple

Pancuronium bromide (PB) is used in neonates and pregnant women to induce limp, flaccid paralysis in order to allow mechanical ventilation during intensive care. Such non-depolarizing neuromuscular blocking drugs are administered to 0.1% of all human births in the UK. In this study, we examined PB effects on skeletal development in chick embryos. PB treatment produced skeletal deformities associated with significant reduction in longitudinal growth of all appendicular elements. This was associated with greater cartilage to bone ratios, indicating a preferential reduction in osteogenesis. PB also increased the incidence of knee joint flexion and tibiotarsal joint hyperextension. In addition to limb, spinal and craniofacial deformities, flaccid immobility appears to convert the normal geometric pattern of weight gain to a simple arithmetic accretion. This novel study highlights the potentially harmful effects of pharmacologically induced flaccid immobility on chick embryonic skeletal development. Whilst in ovo avian development clearly differs from human, our findings may have implications for the fetus, premature and term neonate receiving such non-depolarizing neuromuscular blocking drugs.

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Animals; Bone and Bones; Bone Development; Chick Embryo; Joints; Limb Deformities, Congenital; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pancuronium; Weight Gain

The well-known ability of real-time ultrasound to detect congenital abnormalities is often limited by acoustic artifact or fetal position or both. Magnetic resonance imaging can provide superior soft tissue resolution but is vulnerable to maternal and fetal motion artifact. Described and illustrated here is a case of fetal holoprosencephaly that was not of diagnostic clarity on ultrasound. The fetus was paralyzed with an intramuscular injection of pancuronium bromide before a resonance imaging study. Successful fetal paralysis with pancuronium bromide has been reported prior to a variety of fetal interventions for the temporary arrest of fetal movement. The resonance study illustrated here was of significantly superior clarity and improved the accuracy of prognosis and management counseling. It is concluded that in selected cases where ultrasound is not of diagnostic clarity due to acoustic artifact, fetal paralysis and magnetic resonance imaging may be considered.

Topics: Abnormalities, Multiple; Adult; Brain; Female; Fetal Movement; Humans; Magnetic Resonance Imaging; Pancuronium; Pregnancy; Prenatal Diagnosis