pancuronium and Acidosis

Topics: Acidosis; Aminopyridines; Electric Stimulation; Humans; Hypothermia; Kidney Diseases; Liver Diseases; Neostigmine; Neuromuscular Blocking Agents; Neuromuscular Junction; Pancuronium; Peripheral Nerves; Respiration; Sensory Receptor Cells; Synaptic Transmission; Water-Electrolyte Balance

The mechanisms of action of monoamine oxidase inhibitors (MAOIs) suggest that patients taking them may respond with hyper- or hypotension when undergoing coronary artery surgery. We describe a case where MAOIs were present and fentanyl and midazolam were the anaesthetic agents used. The anaesthesia and surgery were performed without incident. Postoperative ICU care was complicated by hypertension, hyperthermia, and severe shivering followed by hypotension resistant to therapy and finally death. Diagnoses of pulmonary embolism and sepsis were unproven and may have played a role. The MAOIs may also have played a role. Reactions in patients while taking both meperidine and MAOIs are unusual and animals react differently from humans to a combination of MAOIs and narcotics. There are only five reported cases where fentanyl was given to patients on MAOIs. We conclude that, until there is more information, MAOIs should be discontinued, if possible, before surgery in which catecholamines may be needed.

Topics: Acidosis; Anesthesia, Intravenous; Angina, Unstable; Cause of Death; Coronary Artery Bypass; Fentanyl; Humans; Hypoxia; Male; Midazolam; Middle Aged; Myocardial Infarction; Pancuronium; Pulmonary Edema; Tranylcypromine

Topics: Acidosis; Anesthesia; Benzocaine; Female; Fentanyl; Humans; Infant, Newborn; Intraoperative Complications; Methemoglobinemia; Pancuronium

The effects of acute acid-base changes on the neuromuscular blocking action of ORG NC 45 (a monoquaternary homologue of pancuronium) were measured in 10 cats, utilizing a constant infusion technique. Partial NC 45 blockade was antagonized slightly in the tibialis, soleus, and diaphragm during respiratory alkalosis (pH 7.53; PaCO2 1.9 kPa), whereas metabolic alkalosis (pH 7.64; Paco2 3.5 kPa) produced significant antagonism of NC 45 block in those muscles. Respiratory acidosis (pH 6.98; Paco2 10.3 kPa) and metabolic acidosis (p H 7.13; PaCO2 4.9 kPa) significantly potentiated partial NC 45 blocks in the tibialis, soleus, and diaphragm (except in the diaphragm during metabolic acidosis). Cumulative dose responses studied in six cats showed that the NC 45 dosage required to produce 85--95% tibialis block was slightly greater than controls during respiratory and metabolic alkalosis. Conversely, significantly less NC 45 was needed to produce the same degree of block during respiratory and metabolic acidosis. In vitro studies in rat hemidiaphragms likewise showed minimal NC 45 block antagonism when pH was raised to 7.68, and significant potentiation under acidotic conditions (pH 7.05). These actions are attributed in part to an increased rate of NC 45 metabolism by alkaline hydrolysis in alkalotic states and greater molecular stability during acidosis. Possible clinical implications are discussed.

Topics: Acidosis; Acidosis, Respiratory; Alkalosis; Alkalosis, Respiratory; Animals; Cats; Dose-Response Relationship, Drug; Drug Synergism; Neuromuscular Blocking Agents; Pancuronium; Rats; Vecuronium Bromide

The effects of pancuronium bromide (Pavulon) on maternal circulation and metabolism as well as on fetal metabolism and postnatal conditions were studied in 13 women in late pregnancy (between gestational weeks 33 and 40) requiring Caesarean section in general anaesthesia. A comparison with results of 50 spontaneous deliveries without analgetics was performed. The average dosage of 4 mg did not effect the maternal blood pressure, fetal muscle tonus and cardiorespiratory adaption of the newborn. According to general anaesthesia we found in acid-base status a pH decrease with respiratory acidosis in comparison with spontaneous deliveries without anaesthetics, but pH and pCO2 were normalized 30 min after delivery. On the contrary, the oxygen tension were higher as at delivery as 30 min after delivery by Caesarean section. Although 1 minute Apgar score was lower than after spontaneous delivery the heart rate and frequency of ventilation were normal in every time and in the following minutes Apgar score was 7 to 10, too. An effect of pancuronium bromide to maternal or fetal carbohydrate metabolism could not be found. The less side effects on maternal cardiovascular system and the missing influence in postnatal condition recommand pancuronium bromide as a suitable relaxant in obstetrical anaesthesia, too.

Topics: Acidosis; Anesthesia, General; Apgar Score; Blood Circulation; Cesarean Section; Female; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Pancuronium; Pregnancy

Topics: Acidosis; Anesthesia, General; Arrhythmias, Cardiac; Dextrans; Evaluation Studies as Topic; Fentanyl; Halothane; Heart Defects, Congenital; Humans; Hypothermia, Induced; Infant; Infant, Newborn; Pancuronium; Potassium; Time Factors; Vasodilation

Topics: Acid-Base Equilibrium; Acidosis; Animals; Ascorbic Acid; Blood; Blood Pressure; Carbon Dioxide; Cats; Decamethonium Compounds; Depression, Chemical; Diaphragm; Hydrochloric Acid; Hydrogen-Ion Concentration; In Vitro Techniques; Muscle Contraction; Pancuronium; Partial Pressure; Phrenic Nerve; Rats; Succinylcholine; Tibia; Trimethadione

Topics: Acidosis; Anemia; Anesthesia, Epidural; Anesthesia, General; Carbon Dioxide; Gallamine Triethiodide; Halothane; Heart Arrest; Humans; Hyperkalemia; Kidney Transplantation; Magnesium; Methoxyflurane; Nitrous Oxide; Oxygen; Pancuronium; Potassium; Renal Dialysis; Transplantation, Homologous; Tubocurarine; Urea