pancuronium and Asthma

Pancuronium bromide is a nondepolarizing muscle relaxant approved to induce skeletal muscle relaxation during anesthesia and to facilitate the management of patients undergoing mechanical ventilation. The use of pancuronium bromide during surgery led to the appreciation that it has advantages over drugs previously used for muscle relaxation. Patients in whom pancuronium bromide is of value are (1) hypoxemic patients resisting mechanical ventilation and so cardiovascularly unstable that use of sedatives is precluded, (2) patients with bronchospasm unresponsive to conventional therapy, (3) patients with severe tetanus or poisoning where muscle spasm prohibits adequate ventilation, (4) patients with status epilepticus unable to maintain their own ventilation, (5) shivering patients in whom metabolic demands for oxygen should be reduced, and (6) patients requiring tracheal intubation in whom succinylcholine administration is contraindicated. Without concomitant sedation, use of pancuronium bromide is associated with psychological risks. Other risks are undetected ventilator disconnection, tachyarrythmias, prolonged paralysis and drug interactions.

Topics: Animals; Asthma; Drug Interactions; Humans; Hypothermia; Intubation, Intratracheal; Pancuronium; Poisoning; Respiratory Distress Syndrome; Status Epilepticus; Tetanus

Topics: Anesthesia, Inhalation; Anesthesia, Obstetrical; Asthma; Female; Glaucoma; Histamine Release; Humans; Liver Diseases; Maternal-Fetal Exchange; Muscle Relaxants, Central; Pancuronium; Pregnancy; Shock, Hemorrhagic; Urologic Diseases

Acute myopathy following mechanical ventilation for near-fatal asthma (NFA) has been described recently, and some researchers have suggested that this complication is related to the use of neuromuscular blocking agents (NMBAs) and corticosteroids (CSs).. To determine the incidence of acute myopathy in a group of patients and to examine the most important predictors of its development.. A retrospective cohort study over a 10-year period (1985 to 1995) of all asthma patients who received mechanical ventilation at two centers in Vancouver (designated center 1 and center 2).. In center 1, there were 58 patients who had 64 episodes of NFA, and in center 2, there were 28 patients who had 30 episodes. NMBAs were used in 30 of 86 admissions for acute severe asthma (35%). The mean (+/- SD) duration of muscle paralysis was 3.1+/-2.3 days. A total of 9 patients (10.4%) developed significant myopathy. The incidence of myopathy was 9 of 30 (30%) among patients who received NMBAs. In a multiple logistic regression model, the development of myopathy was only significantly associated with the duration of muscle relaxation. The odds ratio for the development of myopathy increased by 2.1 (95% confidence interval, 1.4 to 3.2) with each additional day of muscle relaxation. The dose and the type of the CS were not significantly associated with the myopathy in the multiple logistic regression analysis.. Our study showed that there is a high incidence of acute myopathy when NMBAs are used for NFA. The incidence of myopathy increases with each additional day of muscle relaxation.

Topics: Acute Disease; Adult; APACHE; Asthma; Electromyography; Female; Follow-Up Studies; Glucocorticoids; Humans; Hydrocortisone; Incidence; Male; Methylprednisolone; Middle Aged; Neuromuscular Blocking Agents; Neuromuscular Diseases; Odds Ratio; Pancuronium; Respiration, Artificial; Retrospective Studies

Patients who undergo mechanical ventilation for severe asthma are at risk of developing diffuse muscle weakness because of acute myopathy. The relative importance of corticosteroids and neuromuscular paralysis in causing the myopathy is controversial, and it is uncertain whether the chemical structure of the drug used to induce paralysis influences the risk of myopathy. Using a retrospective cohort study design, we evaluated 107 consecutive episodes of mechanical ventilation for severe asthma to assess (1) the incidence of clinically significant weakness in patients treated with corticosteroids alone versus corticosteroids with neuromuscular paralysis, (2) the influence of the duration of paralysis on the incidence of muscle weakness, and (3) the relative risk of weakness in patients paralyzed with the nonsteroidal drug atracurium versus an aminosteroid paralytic agent (pancuronium, vecuronium). The use of corticosteroids and a neuromuscular blocking agent was associated with a much higher incidence of muscle weakness as compared with the use of corticosteroids alone (20 of 69 versus O of 38, p < 0.001). The 20 weak patients were paralyzed significantly longer than the 49 patients who received a neuromuscular blocking agent without subsequent weakness (3.4 +/- 2.4 versus 0.6 +/- 0.7 d, p < 0.001). Eighteen of the 20 weak patients had been paralyzed for more than 24 h. The incidence of weakness was not reduced when paralysis was achieved with atracurium as opposed to an aminosteroid neuromuscular blocking agent. In conclusion, corticosteroid-treated patients with severe asthma who undergo prolonged neuromuscular paralysis are at significant risk for the development of muscle weakness, and the risk of weakness is not reduced by use of atracurium.

Topics: Acute Disease; Adolescent; Adult; Aged; Albuterol; Asthma; Atracurium; Bronchodilator Agents; Cohort Studies; Female; Glucocorticoids; Humans; Incidence; Male; Methylprednisolone; Middle Aged; Muscle Weakness; Muscular Diseases; Neuromuscular Nondepolarizing Agents; Pancuronium; Respiration, Artificial; Retrospective Studies; Risk Factors; Time Factors; Vecuronium Bromide

Topics: Asthma; Bronchial Spasm; Conscious Sedation; Female; Humans; Infusions, Intravenous; Ketamine; Midazolam; Middle Aged; Myocardial Infarction; Pancuronium; Respiration, Artificial; Status Asthmaticus

Topics: Asthma; Female; Humans; Hydrocortisone; Middle Aged; Muscular Atrophy; Pancuronium; Status Asthmaticus

Topics: Adult; Aged; Asthma; Female; Humans; Hydrocortisone; Male; Muscular Dystrophies; Pancuronium; Status Asthmaticus

Topics: Adult; Asthma; Female; Humans; Muscular Atrophy; Neuromuscular Junction; Pancuronium; Respiration, Artificial; Respiratory Care Units; Status Asthmaticus; Time Factors

A 17 year old male with a history of bronchial asthma was admitted to the intensive care unit in severe respiratory distress. During a two week period of intensive respiratory care he received large doses of aminophylline and corticosteroids. In addition, pancuronium was given to facilitate ventilation and to reduce airway pressure. Large doses of pancuronium, as much as 5 mg/hr, were required to stop spontaneous respiratory efforts and restlessness. The total pancuronium dose given during the two week period was 800 mg. One hour after pancuronium was discontinued the patient could open his eyes and move his lips. Peripheral nerve stimulation indicated partial paralysis which improved promptly following a test dose of edrophonium. The authors speculate the aminophylline, which is a known inhibitor of the enzyme phosphodiesterase, raised the level of c-AMP and, in turn, the level of acetylcholine at the neuromuscular junction and thus antagonized the blocking effect of pancuronium. In addition, the large doses of corticosteroids that the patient had received may have enhanced the release of acetylcholine and further facilitated neuromuscular transmission.

Topics: Adolescent; Adrenal Cortex Hormones; Aminophylline; Anesthesia; Asthma; Drug Interactions; Drug Resistance; Humans; Male; Pancuronium

The authors have added to the usual therapy (corticoids, antibiotics, bronchodilatators) of 13 cases of status asthmaticus the following association: sodic gamma hydroxybutyrate and pancuronium bromid so they have noted in every case of quick decrease of bronchospasm allowing the stopping of the mechanical ventilation.

Topics: Adult; Asthma; Drug Therapy, Combination; Female; Humans; Hydroxybutyrates; Male; Middle Aged; Pancuronium; Respiration, Artificial; Sodium Oxybate

A review of clinical and experimental data pertaining to drug-induced asthma is presented. Various drugs and drug additives causing asthma are classified and their possible modes of action in inducing asthma are discussed. Practical recommendations for diagnosis and prevention of drug-induced asthma are enumerated.

Topics: Alfaxalone Alfadolone Mixture; Aspirin; Asthma; Azo Compounds; Bronchial Spasm; Coloring Agents; Contrast Media; Cromolyn Sodium; Humans; Isoproterenol; Pancuronium

Topics: Adult; Asthma; Humans; Hydroxybutyrates; Middle Aged; Pancuronium; Sodium Oxybate; Ventilators, Mechanical

A detailed review of drug-induced bronchospasm is presented. Four types of reactions are described. Furthermore, pathogenesis, clinical picture, treatment and prophylaxis of the "Aspirin-induced asthma" are demonstrated.

Topics: Adrenal Cortex Hormones; Aspirin; Asthma; Bronchi; Bronchial Spasm; Drug Hypersensitivity; Female; Humans; Male; Pancuronium; Peptide Hydrolases; Proteins; Tartrazine; Thiopental

Topics: Adolescent; Adult; Aged; Anesthesia, General; Asthma; Child; Drug Synergism; Female; Humans; Ketamine; Male; Middle Aged; Pancuronium; Respiration

Topics: Androstanes; Arrhythmias, Cardiac; Asthma; Heart; Heart Rate; Humans; Neuromuscular Nondepolarizing Agents; Pancuronium

Topics: Aminophylline; Androstanes; Asthma; Bronchial Spasm; Ephedrine; Humans; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Oxygen; Pancuronium; Respiration, Artificial; Skin Tests

Topics: Adolescent; Adult; Androstanes; Asthma; Blood Gas Analysis; Bromides; Carbon Dioxide; Child; Female; Humans; Hydrogen-Ion Concentration; Male; Neuromuscular Nondepolarizing Agents; Oxygen; Pancuronium