pancuronium and Fasciculation

Fasciculations during rapid-sequence intubation may lead to increased intracranial pressure and emesis with aspiration. Standard rapid-sequence intubation requires a nondepolarizing blocking agent before succinylcholine administration.. Prevention of fasciculations during rapid-sequence intubation of head trauma patients can be accomplished as safely and effectively with minidose succinylcholine as with a defasciculating dose of pancuronium.. A prospective, randomized, double-blind study.. An inner-city county trauma center with 70,000 patient visits per year.. Sequential adult head trauma patients requiring rapid-sequence intubation who had no contraindications to succinylcholine or pancuronium.. Each head trauma patient requiring rapid-sequence intubation who met the inclusion criteria received standard rapid-sequence intubation maneuvers and lidocaine (1 mg/kg) IV. Patients were randomized to receive either minidose succinylcholine (0.1 mg/kg) or pancuronium (0.03 mg/kg) IV one minute prior to the full paralytic dose of succinylcholine (1.5 mg/kg) IV. Fasciculations were recorded using a graded visual scale.. Of 46 patients, eight of 19 (42%) in the pancuronium group and six of 27 (22%) in the succinylcholine group experienced fasciculations. No statistically significant difference in fasciculations was detected between the two groups using chi 2 analysis. Complete relaxation of the cords was present in all but two patients, one in each group. No patient in either group experienced emesis or significant dysrhythmias.. Pretreatment with minidose succinylcholine causes no greater incidence of fasciculations than pancuronium in rapid-sequence intubation of head trauma patients in an ED setting. Thus succinylcholine may be used as the sole paralytic agent in rapid-sequence intubation of head trauma patients.

Topics: Adult; Craniocerebral Trauma; Double-Blind Method; Emergencies; Fasciculation; Humans; Intubation, Intratracheal; Pancuronium; Prospective Studies; Succinylcholine

Muscle pain associated with single-bolus administration of suxamethonium is reported to be one of the common complications of this technique. Since suxamethonium is the most commonly used relaxant in our department and priming with nondepolarizing muscle relaxants is also reported to be linked with complications, while the literature concerning this problem is very contradictory, we wondered if the so-called "self-taming" method represents an alternative to pretreatment with nondepolarizing muscle relaxants. One hundred thirty-two patients (69 male, 63 female) were randomly allocated to three groups. Anesthesia was induced with thiopentone 7 mg/kg body weight. Group 1 (n = 44) was pretreated with 2 mg pancuronium bromide 3 min prior to full relaxation with suxamethonium 1.5 mg/kg. Group 2 (n = 43) received no pretreatment. Group 3 (n = 45) received 4 mg suxamethonium i.v. after induction. One minute later the remaining dose of suxamethonium was applied ("self-taming"). Muscle fasciculation and postoperative myalgia were verified by means of a score. Neuromuscular transmission was recorded on a monitor after controlled train-of-four stimulus and time of onset of neuromuscular blockade was measured. With regard to muscle fasciculation, postoperative pain, and onset of neuromuscular blockade, "self-taming" with suxamethonium yielded results identical to pretreatment with pancuronium bromide. It may therefore be considered as an alternative to pretreatment with nondepolarizing muscle relaxants.

Topics: Adult; Anesthesia, General; Drug Administration Schedule; Fasciculation; Female; Humans; Male; Middle Aged; Muscle Contraction; Muscle Relaxation; Neuromuscular Junction; Pain; Pancuronium; Succinylcholine

The purpose of the study was to determine the effect of nondepolarizing muscle relaxants and waiting time on muscle fasciculations after succinylcholine in anaesthetized patients. Adult men and women, 60-80 kg, received pretreatment doses of atracurium 5 mg (n = 160), pancuronium 1 mg (n = 123), d-tubocurarine 3 mg (n = 97), or vecuronium 1 mg (n = 62). Waiting times between pretreatment and succinylcholine, 100 mg, ranged between 0.6 and 5 min. Data points (presence or absence of fasciculations and waiting time) were entered for each patient. Waiting time response curves were obtained between the logit transformation of the probability of no fasciculations and the log waiting time for each drug. Statistical differences between wait time response curves were determined by non-overlapping of the associated 95% confidence intervals. The frequency of muscle fasciculations was reduced with increased waiting time for all nondepolarizers tested. Following wait times of three, four and five minutes, the probability of not fasciculating was greatest with d-tubocurarine (90, 97 and 99%, respectively) and atracurium (89, 93 and 96%). Corresponding values for pancuronium were 70, 82 and 88% and for vecuronium were 74, 82 and 86%. Waiting times to prevent fasciculations in 80% and 90% of patients were shorter with d-tubocurarine (2.46 and 3.02 min, respectively) or atracurium (2.16 and 3.24 min) than pancuronium (3.77 and 5.35 min) or vecuronium (3.73 and 6.36 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Atracurium; Cough; Fasciculation; Female; Humans; Incidence; Intubation, Intratracheal; Male; Neuromuscular Nondepolarizing Agents; Pancuronium; Preanesthetic Medication; Prospective Studies; Sex Factors; Succinylcholine; Time Factors; Tubocurarine; Vecuronium Bromide

The purpose of this study was to gain new insights in the role of succinylcholine in the initiation of malignant hyperthermia (MH). The intravenous (i.v.) administration of succinylcholine (2.0 mg/kg) induced fasciculations and masseter spasm in both normal swine and those susceptible to MH. However, the amplitudes and durations of generalized fasciculations were significantly greater in the susceptible animals that subsequently developed a fulminant episode of MH: succinylcholine induced not only tachycardia, hyperthermia, contractures, and increases in PaCO2 and lactate, all classic indicators of an episode, but also an initial severe hypotension. The mean arterial pressure in these swine decreased from 115 +/- 6 mm Hg to 60 +/- 12 mm Hg (mean +/- SD), 1 min after the administration of succinylcholine. Normal swine developed neither cardiovascular effects nor altered metabolism in response to succinylcholine. The pretreatment of animals with a nondepolarizing muscle relaxant (pancuronium 0.1 mg/kg) minimized fasciculations induced by succinylcholine, but did not prevent the hypotension nor episodes of MH in the susceptible swine. In the pretreated and untreated susceptible swine, dantrolene was an equally effective treatment. Plasma catecholamine levels after succinylcholine administration were increased only in the susceptible swine without the pancuronium pretreatment. We concluded that the effects of succinylcholine on skeletal muscle and/or on other tissues play a significant role in the initiation of a MH episode in swine with this genetic disorder, and that these effects are not dependent on an abnormal sensitivity for succinylcholine-induced skeletal muscle fasciculations in these animals.

Topics: Action Potentials; Afferent Pathways; Animals; Carbon Dioxide; Catecholamines; Electromyography; Fasciculation; Heart Rate; Malignant Hyperthermia; Muscles; Pancuronium; Succinylcholine; Swine

The effects of iv succinylcholine (SCh) on cerebral blood flow (CBF), muscle afferent activity (MAA), electromyographic activity (EMG), visible fasciculations, and PaCO2 were tested in 12 dogs anesthetized with 0.87% end-expired halothane (1 MAC). Six dogs (group I) received treatments of both SCh 1.0 mg/kg iv and saline placebo 3.0 ml iv. Fasciculations and substantial increases in EMG activity were observed in all six dogs given SCh. At the onset of fasciculations, there were parallel increases in MAA and CBF to peak values of 466% +/- 77% of control (mean +/- SE) and 136% +/- 5% of control, respectively, at the 1-min measurement point. Thereafter, both MAA and CBF declined toward control values. An additional six dogs (group II) were prepared as above; however, they were pretreated with a defasciculating dose of pancuronium 0.01 mg/kg iv 5 min before being given SCh 1.0 mg/kg. These dogs were also given treatments of saline placebo 3.0 ml iv during another portion of the study. None of these six dogs had visible fasciculations following SCh, and only in one was slight EMG activity detected. Following iv SCh, there were parallel increases in both MAA and CBF. The peak MAA value of 255% +/- 56% of control occurred at the 1-min measurement point and was followed by a gradual decline in MAA. CBF increases were greatest during the periods of greatest MAA (i.e., the 1- to 3-min measurement points). The largest increase in CBF (128% +/- 9% of control) occurred at the 3-min measurement point.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Afferent Pathways; Animals; Blood Pressure; Brain; Cerebrovascular Circulation; Dogs; Drug Interactions; Electroencephalography; Electromyography; Fasciculation; Halothane; Injections, Intravenous; Intracranial Pressure; Muscles; Oxygen Consumption; Pancuronium; Succinylcholine

Topics: Adolescent; Adult; Aged; Fasciculation; Female; Humans; Male; Middle Aged; Neuromuscular Junction; Pancuronium; Succinylcholine; Tubocurarine; Vecuronium Bromide

The prophylactic effectiveness of a small "self-taming" dose of succinylcholine (0.1 mg X kg-1), of d-tubocurarine (0.05 mg X kg-1), and of pancuronium (0.02 mg X kg-1) on succinylcholine-induced fasciculations and myoglobinaemia was studied in 64 healthy children (ages two to nine years), anaesthetized with halothane, nitrous oxide and oxygen. Serum myoglobin was analyzed by radioimmunoassay and taken as a tracer of muscle damage. No correlation was found between the serum levels of myoglobin and the incidence of muscle fasciculations. Self-taming with succinylcholine decreased the incidence of fasciculations (p = 0.001) but did not decrease the succinylcholine-induced myoglobinaemia (p = 0.224). D-tubocurarine (0.05 mg X kg-1) and pancuronium (0.02 mg X kg-1) both significantly reduced the myoglobinaemia and the fasciculations produced by succinylcholine. The pancuronium pretreated group presented less variable values of serum myoglobin which, when compared to the control group, had a more significant p value (p less than 0.001) than for d-tubocurarine pretreated group (p = 0.003). Muscle fasciculations and increased myoglobin levels were observed in children less than four years old who received succinylcholine. The prophylaxis of acute rhabdomyolytic renal failure due to succinylcholine (seven cases reported in the medical literature) is considered.

Topics: Age Factors; Anesthesia, General; Child; Child, Preschool; Drug Administration Schedule; Fasciculation; Female; Halothane; Humans; Intubation, Intratracheal; Male; Myoglobin; Nervous System Diseases; Nitrous Oxide; Pancuronium; Preanesthetic Medication; Succinylcholine; Tubocurarine

Tubocurarine 0.05 and 0.07 mg.kg-1, gallamine 0.1 and 0.2 mg.kg-1 and pancuronium 0.01 and 0.02 mg.kg-1 given three minutes before suxamethonium 1.0, 1.5 and 2 mg.kg-1 in groups of 10 patients each (total 210 patients) to compare ease of tracheal intubation and incidence of post-suxamethonium muscle pain. These were compared with a control group of suxamethonium 1.0, 1.5 and 2 mg.kg-1 given alone after thiopentone 5 mg.kg-1. On analysis, tubocurarine 0.07 mg.kg-1 and suxamethonium 2 mg.kg-1 was the ideal combination with the best intubation conditions and the lowest incidence of post-suxamethonium muscle pains. The second best combination was gallamine 0.2 mg.kg-1 and suxamethonium 2 mg.kg-1. Pancuronium 0.01 mg.kg-1 and 0.02 mg.kg-1 in combination with suxamethonium 2 mg.kg-1 were satisfactory, although less efficient than the combination with either tubocurarine or gallamine.

Topics: Adult; Body Weight; Fasciculation; Gallamine Triethiodide; Humans; Intubation, Intratracheal; Muscles; Pain, Postoperative; Pancuronium; Succinylcholine; Tubocurarine