pancuronium and Burns

Topics: Burns; Humans; Infant; Male; Pancuronium; Peritoneal Dialysis

Following severe thermal injury, patients are resistant to non-depolarizing muscle relaxants. Although this resistance has been well documented clinically, little is known about its etiology. We have tested the hypothesis that circulating factors contribute to the decreased potency of neuromuscular blockers following burns. The potencies of d-tubocurarine (2 microM) or pancuronium (2 microM) dissolved in plasma from either burned or control human subjects were tested on the indirectly stimulated (0.2 Hz) rat phrenic nerve-hemidiaphragm preparation. The muscle relaxants produced less neuromuscular blockade when dissolved in plasma from burned patients than when they were dissolved in plasma from controls. Thus, circulating factors are involved in the decreased potency of non-depolarizing neuromuscular blocking drugs.

Topics: Adolescent; Adult; Animals; Burns; Diaphragm; Drug Resistance; Female; Humans; In Vitro Techniques; Male; Muscle Contraction; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Pancuronium; Phrenic Nerve; Rats; Tubocurarine

The efficacy of the combined use of pancuronium and metocurine (Pm-MTC) in high doses to produce rapid-onset muscle paralysis was evaluated in 15 patients with acute burns and 18 recovered burned patients scheduled for reconstructive surgery. Two and three times the previously determined ED95 of the combination for each group was used. (ED95 for Pm-MTC combination is 0.032/0.129 mg/kg for acute burns and 0.013/0.051 mg/kg for reconstructive patients.) Doubling ED95 produced 95% paralysis in 3.1 +/- 0.9 min in acutely burned children and in 4.3 +/- 0.7 min in reconstructive children (mean +/- SEM). These onset times were not significantly different from each other. Tripling the ED95 of the combination in burned children reduced the onset time to 1.3 +/- 0.14 min, but this was not significantly different from 2 X ED95 onset time in burned patients. The administration of 3 X ED95 to the reconstructive group, however, resulted in a significantly more rapid onset time of 1.8 +/- 0.4 min compared with 2 X ED95 in the same population. With 3 X ED95 the onset times between burn and reconstructive patients were not significantly different. Time for recovery of twitch to 25% of control twitch height (75% twitch depression) was significantly prolonged in burned patients compared with reconstructive patients for equipotent doses administered. Although the occasional patient showed prominent changes in heart rate and blood pressure, overall cardiovascular stability was impressive.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Blood Pressure; Burns; Child; Heart Rate; Humans; Pancuronium; Tubocurarine

The quantitative and qualitative aspects of the phenomenon of resistance to competitive (non-depolarizing) neuromuscular blocking agents in burn patients are described. The correlates and temporal features of this resistance are discussed, in addition to therapeutic approaches and the possible mechanisms underlying the resistance.

Topics: Age Factors; Alcuronium; Blood Proteins; Burns; Calcium; Cholinesterases; Dose-Response Relationship, Drug; Drug Resistance; Humans; Liver; Metabolic Clearance Rate; Neuromuscular Depolarizing Agents; Neuromuscular Junction; Pancuronium; Regional Blood Flow; Tubocurarine

The neuromuscular effects of the combined administration of pancuronium and dimethyltubocurarine were evaluated in children undergoing reconstructive surgery (n = 6), or the skin grafting of acute burn wounds: body surface area (BSA) burns less than 40% (n = 5); and BSA burns greater than 40% (n = 6). A dose of pancuronium 0.005 mg kg-1 was considered to be equipotent with dimethyltubocurarine 0.02 mg kg-1, and each dose was defined as being equal to 1 relaxant equivalent (RE). Incremental doses of the combination of pancuronium and dimethyltubocurarine were administered until a 95% depression of twitch height was achieved (ED95). These results were compared with previously published data for pancuronium and dimethyltubocurarine alone. The mean ED95 of the combination in the control population (reconstructive surgery) was 5.1 RE, compared with 10.8 RE and 10.0 RE for pancuronium and dimethyltubocurarine , respectively, administered alone. In the acutely burned population, the mean ED95 for the combination was 9.9 and 15.9 RE, respectively, compared with 26 RE for pancuronium alone in burned patients. In all groups of patients, significantly less total drug was required when the combined therapy was used.

Topics: Burns; Child; Dose-Response Relationship, Drug; Drug Synergism; Humans; Muscle Contraction; Neuromuscular Blocking Agents; Neuromuscular Junction; Pancuronium; Surgery, Plastic; Synaptic Transmission; Tubocurarine

Topics: Adolescent; Burns; Child; Child, Preschool; Dose-Response Relationship, Drug; Hemodynamics; Humans; Muscle Contraction; Neuromuscular Junction; Pancuronium; Synaptic Transmission; Ulnar Nerve

Topics: Adult; Burns; Female; Humans; Male; Neuroleptanalgesia; Pancuronium

Topics: Adult; Anesthesia, General; Burns; Drug Resistance; Female; Humans; Male; Pancuronium

Topics: Anesthesia; Burns; Fentanyl; Humans; Methods; Pancuronium; Shock, Traumatic