pancuronium and Brain-Neoplasms

An awake patient presented with central neurogenic hyperventilation induced by a cerebral tumor. Corticosteroid therapy and brain irradiation while the patient was anesthetized and respiration controlled under pancuronium-induced respiratory paralysis were followed by tumor regression and resolution of hyperventilation. Recurrence of tumor 6 weeks later was not accompanied by recurrence of hyperventilation. Cytologic study of cerebrospinal fluid revealed B-cell lymphoma. This patient brings to 10 the number of cases recorded with tumor-induced central neurogenic hyperventilation. Five of the eight patients with known tumor histology had a primary cerebral lymphoma, a rare neoplasm that comprises only 1% of all intracranial neoplasms. The disproportionately high frequency of central neurogenic hyperventilation in patients with cerebral lymphoma has therapeutic implications that are briefly reviewed.

Topics: Adrenal Cortex Hormones; Brain; Brain Neoplasms; Combined Modality Therapy; Diaphragm; Female; Humans; Hyperventilation; Lymphoma; Middle Aged; Pancuronium; Tomography, X-Ray Computed

Supersensitivity to depolarization produced by succinylcholine and resistance to pancuronium were observed in paretic muscles of a patient with a right frontoparietal tumor. The abnormal sensitivity to relaxants is compared with observations reported in patients with myasthenia gravis and hemiparesis. We hypothesize that upper motoneuron dysfunction may be followed by the appearance of "new" junctional receptors, which may occasional a supersensitivity to depolarization and a poor affinity for both curare and anti-acetylcholine-receptor antibodies. A decrease in acetylcholinesterase activity of "decentralized" muscles should also be considered.

Topics: Action Potentials; Aged; Brain Neoplasms; Electromyography; Hemiplegia; Humans; Male; Neuromuscular Junction; Pancuronium; Reaction Time; Receptors, Cholinergic; Succinylcholine

A case report is presented of a patient receiving chronic phenytoin therapy who demonstrated resistance to pancuronium by increased hourly requirements. Stable neuromuscular blockade was achieved by atracurium infusion at normal rates. Possible explanations for the differences in response to the two non-depolarizing muscle relaxants are discussed.

Topics: Adolescent; Atracurium; Brain Neoplasms; Drug Interactions; Drug Tolerance; Epilepsy; Humans; Infusions, Intravenous; Male; Pancuronium; Parietal Lobe; Phenytoin

The effects of vecuronium 0.1 mg kg-1 on intracranial pressure, heart rate and arterial pressure were evaluated in 20 anaesthetized patients with intracranial tumours undergoing neurosurgery. Apart from a slight decrease in intracranial pressure (-4.9%; ns) which was most probably the result of a concomitant decrease (-14.9%) in central venous pressure, vecuronium 0.1 mg kg-1 was without effect on either cerebral or systemic haemodynamics.

Topics: Anesthesia, General; Blood Pressure; Brain Neoplasms; Central Venous Pressure; Cerebrovascular Circulation; Heart Rate; Humans; Intracranial Pressure; Neuromuscular Blocking Agents; Pancuronium; Vecuronium Bromide

Whether succinylcholine causes an increase in intracranial pressure (ICP) in patients with brain lesions is uncertain and, if increased ICP does occur, its pathophysiology remains unknown. The authors investigated both the effect of succinylcholine on ICP and its modification with prior neuromuscular blockade by measuring ICP (subarachnoid bolt) in 13 consecutive patients with brain tumors who received succinylcholine both before and after complete neuromuscular blockade with vecuronium. Anesthesia was induced with thiopental, 6 mg X kg-1 iv, and nitrous oxide, 70% in oxygen, while ventilation was controlled (PaCO2 = 37.2 mmHg +/- 1.7 SE). Succinylcholine, 1 mg X kg-1 iv, was administered and ICP, heart rate (HR), and blood pressure (BP) were recorded until normal twitch tension was restored. Complete neuromuscular blockade was then established with vecuronium, 0.14 mg X kg-1 iv; 3 min later, succinylcholine, 1 mg X kg-1 iv, was repeated. The resulting changes in ICP, HR, and BP were recorded for 3 min. Following the first dose of succinylcholine, mean ICP increased from 15.2 mmHg +/- 1.3 SE to 20.1 mmHg +/- 2.0 SE (P less than 0.05), with five of the patients sustaining increases in ICP of 9 mmHg or greater. In contrast, when succinylcholine was given after vecuronium-induced paralysis, no patient developed an increase in ICP greater than 3 mmHg (P less than 0.05 compared with the incidence of ICP greater than or equal to 9 mmHg observed after the first dose of succinylcholine). A second group of six patients received two doses of succinylcholine according to the same protocol but without an intervening dose of vecuronium.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Anesthesia, Inhalation; Blood Pressure; Brain Neoplasms; Craniotomy; Drug Interactions; Heart Rate; Humans; Intracranial Pressure; Middle Aged; Neuromuscular Blocking Agents; Nitrous Oxide; Pancuronium; Succinylcholine; Thiopental; Vecuronium Bromide