pancuronium and Brain-Injuries

Controversy and speculation exist regarding intracranial pressure (ICP) changes produced by various combinations of rapid sequence intubation (RSI) agents. In this pilot study, we sought to develop a swine model to investigate these changes in classic RSI.. Eight adult swine were instrumented with arterial and intracranial pressure monitors. Four different versions of rapid sequence intubation were then performed sequentially in each animal in a crossover trial design: regimen 1, thiopental; regimen 2, thiopental and succinylcholine; regimen 3, lidocaine, thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, thiopental, and succinylcholine. ICP and hemodynamic parameters were recorded and compared. Trials were excluded from analysis if baseline ICP measurements were unstable or if intubation was difficult.. Peak changes in ICP were noted at 2 to 3 minutes after administration of induction agents. Mean values for peak changes in ICP were as follows: regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm Hg); regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg (95% CI, -8.3-32.3 mm Hg).. The model is effective. It enables investigators to examine the aggregate ICP effects of combinations of RSI medications. RSI regimens with paralysis produced threefold increases in peak ICP change compared with the sedation-only regimen. Pretreatment agents did not affect ICP changes. Future investigations can examine other agents and add experimental manipulation of ICP to simulate head injury physiology. Additional parameters including cerebral metabolism and/or oxygenation may also be explored.

Topics: Animals; Brain Injuries; Cross-Over Studies; Disease Models, Animal; Emergency Treatment; Intracranial Pressure; Intubation, Intratracheal; Lidocaine; Pancuronium; Pilot Projects; Succinylcholine; Swine; Thiopental

Abnormal hypertension sometimes occurs following intravenous administration (i.v.) of pancuronium in patients with brain injury. The present experiment was designed to determine whether brain injury contributes to the hypertensive response of i.v. pancuronium. Forty-six Wister strain rats were studied, of which 39 had induced brain injury at (a) upper pons (b) midbrain (c) thalamus region (excluding hypothalamus) and (d) cerebellum or a combination of these sites. The injury was made by single insertion of a 22 Gauge needle through the skull surface. The quantity of pancuronium solution administered i.v. in each case was 1.0 ml containing either 0.8 mg/kg or 8 mg/kg of pancuronium. Group A (n = 7) had no brain injury and the mean arterial pressure (MAP) did not change following i.v. administration of pancuronium. In Group B (n = 9) (a+b+c, 8.0 mg/kg) MAP rose from 90.9 +/- 15.4 to 102 +/- 22.0 mmHg and in Group C (n = 7) (a+b+c, 0.8 mg/kg) MAP rose from 148.4 +/- 13.3 to 160 +/- 14.4 mmHg. In Group D (n = 5) (b+c, 8.0 mg/kg) MAP remained unchanged. In Group E (n = 5) (a, 8.0 mg/kg) MAP rose from 130.3 +/- 18.7 to 146 +/- 27.6 mmHg and in Group F (n = 6) (a, 0.8 mg/kg) MAP rose from 129.7 +/- 15.6 to 135.8 +/- 13.8 mmHg. In Group G (n = 7) (d, 8.0 mg/kg) MAP remained unchanged. Since the MAP was elevated in only those groups that received injury in the upper pons, we concluded that injury in the upper pons can lead to hypertension following i.v. administration of pancuronium.

Topics: Animals; Blood Pressure; Brain Injuries; Dose-Response Relationship, Drug; Female; Hypertension; Injections, Intravenous; Male; Osmolar Concentration; Pancuronium; Rats; Rats, Wistar

Severe hypertension, tachycardia or ECG changes have been reported following i.v. administration of pancuronium to patients with pheochromocytoma or bronchial asthma. These cardiovascular changes were explained by an interaction between autonomic effects of pancuronium and elevated serum catecholamines or aminophylline. We noted similar cardiovascular changes associated with i.v. administration of pancuronium in two patients after successful cardiopulmonary resuscitation and in two with midbrain hemorrhage and epidural hematoma. In these patients, pancuronium produced no abnormal cardiovascular changes when given during elective surgery or before the occurrence of midbrain hemorrhage. Thus, ischemic brain damage may play a role in producing the severe cardiovascular changes associated with pancuronium.

Topics: Aged; Brain Injuries; Electrocardiography; Female; Humans; Hypertension; Male; Middle Aged; Pancuronium; Resuscitation; Tachycardia

Topics: Adolescent; Adult; Brain Injuries; Diazepam; Female; Humans; Male; Metabolic Diseases; Muscle Contraction; Pancuronium; Syndrome

There are different opinions about the efficiency of preventing the succinylcholine-induced increase of serum potassium by precurarization. The following case report demonstrates that this method is not practicable in risk patients. A case of severe cerebral trauma is reported, in whom after precurarization with 2,0 mg diallyl-nortoxiferine and with 1.5 mg pancuronium, too, there was an increase of a normal serum potassium level up to 9.35 respectively 9.20 mEq/l about 1-2 minutes after injection of succinylcholine. 20 minutes after the injection serum potassium decreased to a normal level again. Only a short lasting bradycardia was noticed during the hyperkaliaemic period. Similar results reported in the anaesthesiologic literature are discussed.

Topics: Alcuronium; Anesthesia, Intravenous; Brain Injuries; Heart Rate; Humans; Male; Middle Aged; Pancuronium; Potassium; Preanesthetic Medication; Succinylcholine; Toxiferine