pancuronium and Apnea

Thirty infants with birth weights from 580 to 3450 gm (25 to 40 weeks gestation) were prospectively studied during nasotracheal intubation. The infants were randomized to receive atropine 0.01 mg/kg, atropine 0.01 mg/kg plus pancuronium 0.1 mg/kg, or no medication (controls) prior to intubation. There was a significant decrease in transcutaneous PO2 (27.3 torr, P less than 0.02), associated with significant increases in mean arterial blood pressure (57%, P less than 0.01) and intracranial pressure (mean increase 18.9 cm H2O, P less than 0.01) with intubation in all three groups of infants. Only in control infants and infants receiving atropine was there significant decrease in heart rate (52.2 and 36.2 bpm, respectively, P less than 0.01) during intubation. Control infants experienced a significantly greater decrease in heart rate and demonstrated the lowest mean heart rate, compared with the other two groups. Pancuronium plus atropine was associated with lesser increases in intracranial pressure and with the least changes in heart rate in response to intubation. There was no significant difference between the groups for changes in systemic blood pressure or transcutaneous PO2. Further studies are required to determine the clinical consequences, if any, of these responses, and the use of pretreatment in the neonate requiring intubation.

Topics: Apnea; Atropine; Blood Pressure; Heart Rate; Humans; Infant, Newborn; Intracranial Pressure; Intubation, Intratracheal; Pancuronium; Premedication; Prospective Studies; Random Allocation; Respiratory Distress Syndrome, Newborn

A case of Lambert-Eaton myasthenic syndrome (LEMS) revealed by prolonged apnea following the administration of pancuronium during surgery for squamous cell carcinoma of the lung is reported. The postoperative respiratory failure allowed the correct interpretation of a poor clinical picture:slight weakness of the lower limbs and no other signs of neuromuscular disease. In the authors' opinion prolonged apnea always requires accurate neurophysiological investigation in order to detect latent neuromuscular transmission defects which are frequently underevaluated.

Topics: Apnea; Carcinoma, Squamous Cell; Humans; Lambert-Eaton Myasthenic Syndrome; Lung Neoplasms; Male; Middle Aged; Pancuronium

Topics: Apnea; Drug Interactions; Humans; Male; Middle Aged; Neostigmine; Pancuronium; Postoperative Complications; Verapamil

A method is described for obtaining consistently high-quality images during nonneurologic computed tomography of the severely ill and uncooperative patient using a neuromuscular blocker to induce apnea. Careful control of respiration during data acquisition eliminates motion artifacts.

Topics: Apnea; Critical Care; Humans; Pancuronium; Radiography, Abdominal; Radiography, Thoracic; Respiration; Tomography, X-Ray Computed

We measured impedances of the respiratory system (Zrs) and lung (ZL) in anesthetized and paralyzed dogs at frequencies between 4 and 64 Hz. Zrs was measured at functional residual capacity (FRC) and with mean transpulmonary pressures (Ptp) of 12 and 30 cmH2O; ZL was measured with the chest wall open at FRC and Ptp = 12 cmH2O. From these data we derived chest wall impedances at FRC and 12 cmH2O. Effective resistances of the respiratory system, lung, and chest wall were all frequency dependent. At frequencies below 22 Hz frequency dependence of respiratory system resistance was due to the frequency dependence of the chest wall, whereas at higher frequencies it was due to frequency dependence of the lung. Analysis of the impedance data between 4 and 32 Hz provided estimates of resistance, inertance, and compliance of the lung, chest wall, and respiratory system. At FRC, 41% of the respiratory system resistance was due to the lung and 59% was associated with the chest wall. Nearly all of the respiratory inertance (98%) was due to the lung. Lung compliance was approximately twice that of the chest wall, the former accounting for approximately one-third of respiratory elasticity. As lung volume was increased, respiratory resistance and compliance decreased; inertance also decreased, although this change was not significant.

Topics: Airway Resistance; Anesthesia, Intravenous; Animals; Apnea; Bromides; Dogs; Lung; Lung Compliance; Lung Volume Measurements; Pancuronium; Plethysmography, Impedance; Pressure; Respiration; Thorax

Over a 10-year period 12,643 gynecologic surgical procedures were performed with the patients under general anesthesia. Succinylcholine was the muscle relaxant used in the majority of cases. Four of these patients developed prolonged postoperative apnea; the longest period of apnea was 6 hours. In one patient atypical cholinesterase was documented, and two of the patients were subsequently diagnosed as having myasthenia gravis. In the fourth case an etiology for the apnea was not demonstrated. A compilation of drugs in common clinical usage which interfere with neuromuscular transmission is included.

Topics: Adult; Apnea; Cholinesterases; Female; Genital Diseases, Female; Humans; Infant, Newborn; Middle Aged; Myasthenia Gravis; Pancuronium; Postoperative Complications; Retrospective Studies; Succinylcholine

Topics: Apnea; Cholinesterase Inhibitors; Drug Resistance; Humans; Male; Middle Aged; Pancuronium