pancuronium and Heart-Arrest

The mortality of severe tetanus (grades II-III) remains high today, being greater than 20% with a large number of complications, due to the lengthy stay of these patients in the ICU.. A review of 13 cases of severe tetanus over the last 5 years was performed analyzing age, entrance, previous immunization, ICU stay, grade of severity, complications and mortality.. The ages ranged between 35 to 79 years (mean 54 years). No patient had been previously immunized. Entrance was determined in 11 patients (84.6%). The mean ICU stay was 27.3 days. Complications were presented in 76.8% of the patients, with the most frequent being vegetative alterations (38%). The global mortality was 30.7% (4 patient), 3 secondary to sepsis of pulmonary origin and one from a cardiac arrest of vegetative etiology.. The authors believe that prophylaxis is fundamental in prevention of the disease but an important sector of the population remains unvaccinated. On appearance of severe tetanus, admission to the ICU is essential since many complications may appear requiring specialized techniques and personnel.

Topics: Acinetobacter Infections; Adult; Aged; Cause of Death; Combined Modality Therapy; Debridement; Diazepam; Female; Heart Arrest; Humans; Hypoxia, Brain; Immunoglobulins, Intravenous; Intensive Care Units; Male; Middle Aged; Muscle Relaxants, Central; Neuromuscular Nondepolarizing Agents; Pancuronium; Penicillins; Physical Therapy Modalities; Pneumonia, Bacterial; Retrospective Studies; Sepsis; Severity of Illness Index; Spain; Tetanus; Tetanus Toxoid

Topics: Age Factors; Anesthesia, General; Arrhythmias, Cardiac; Atropine; Butylscopolammonium Bromide; Ciliary Body; Gallamine Triethiodide; Glycopyrrolate; Heart Arrest; Humans; Nerve Block; Ophthalmologic Surgical Procedures; Pancuronium; Reflex; Reflex, Oculocardiac; Strabismus; Trigeminal Nerve; Vagus Nerve

Topics: Bradycardia; Cholinesterases; Gallamine Triethiodide; Heart Arrest; Humans; Hyperkalemia; Infant; Infant, Newborn; Intraocular Pressure; Monitoring, Physiologic; Muscular Diseases; Myotonia; Neuromuscular Blocking Agents; Neuromuscular Depolarizing Agents; Neuromuscular Junction; Pancuronium; Postoperative Complications; Succinylcholine; Time Factors; Tubocurarine

Present practice guidelines recommend sedative-analgesic and neuromuscular blocking administration during therapeutic hypothermia in comatose patients after cardiac arrest. However, none suggests the best administration protocol. In this study, we evaluated intensivists' preferences regarding administration.. A systematic literature review was conducted to identify clinical studies published between 1997 and July 2009. Selected articles had to meet the following criteria: use of hypothermia to improve neurologic outcome after cardiac arrest, and specific mention of the sedative protocol used. We checked drugs and dose used, the reason for their administration, and the specific type of neurologic and neuromuscular monitoring used.. We identified 44 studies reporting protocols used in 68 intensive care units (ICUs) from various countries. Midazolam, the sedative used most often, was used in 39 ICUs at doses between 5 mg/h and 0.3 mg/kg/h. Propofol was used in 13 ICUs at doses up to 6 mg/kg/h. Eighteen ICUs (26%) did not report using any analgesic. Fentanyl was the analgesic used the most, in 33 ICUs, at doses between 0.5 and 10 microg/kg/h, followed by morphine in 4 ICUs. Neuromuscular blocking drugs were routinely used to prevent shivering in 54 ICUs and to treat shivering in 8; in 1 ICU, their use was discouraged. Pancuronium was used the most, in 24 ICUs, followed by cisatracurium in 14. Four ICUs used neuromuscular blocking drug administration guided by train-of-four monitoring and 3 ICUs used continuous monitoring of cerebral activity.. There is great variability in the protocols used for anesthesia and analgesia during therapeutic hypothermia. Very often, the drug and the dose used do not seem the most appropriate. Only 3 ICUs routinely used electroencephalographic monitoring during paralysis. It is necessary to reach a consensus on how to treat this critical care population.

Topics: Analgesia; Analgesics, Opioid; Anesthesia; Clinical Protocols; Critical Care; Heart Arrest; Humans; Hypnotics and Sedatives; Hypothermia, Induced; Nervous System Diseases; Neuromuscular Blocking Agents; Neuromuscular Nondepolarizing Agents; Pancuronium; Practice Guidelines as Topic; Shivering; Systematic Reviews as Topic; Treatment Outcome

While being treated for the acute respiratory distress syndrome, a 27-year-old woman developed profound hyperkalemia and cardiac arrest following the administration of succinylcholine chloride (SCh). She had none of the risk factors previously described for development of severe hyperkalemia following SCh administrations; however, she had been intermittently treated with nondepolarizing neuromuscular blocking drugs throughout the course of her illness. We suggest that immobilization of critically ill patients with pharmacologic neuromuscular blockade may predispose them to severe hyperkalemia and cardiac arrest following administration of SCh. SCh should be used with great caution in such patients.

Topics: Adult; Electrocardiography; Female; Heart Arrest; Humans; Hyperkalemia; Neuromuscular Depolarizing Agents; Pancuronium; Succinylcholine; Vecuronium Bromide

Topics: Adult; Anesthesia, Intravenous; Cardiopulmonary Bypass; Cardiopulmonary Resuscitation; Diazepam; Fentanyl; Heart Arrest; Heart Failure; Heart-Lung Transplantation; Humans; Hypertension, Pulmonary; Male; Pancuronium; Succinylcholine

Topics: Adult; Aged; Female; Heart Arrest; Humans; Intraoperative Complications; Neuromuscular Blocking Agents; Pancuronium; Vecuronium Bromide

Topics: Anesthetics; Arrhythmias, Cardiac; Blood Pressure; Bradycardia; Drug Combinations; Fentanyl; Heart Arrest; Humans; Male; Middle Aged; Neuromuscular Blocking Agents; Pancuronium; Sufentanil; Vecuronium Bromide

Topics: Aged; Female; Heart Arrest; Humans; Intraoperative Complications; Neuromuscular Blocking Agents; Pancuronium; Vecuronium Bromide

Topics: Adult; Arrhythmias, Cardiac; Female; Heart Arrest; Humans; Intraoperative Complications; Neuromuscular Blocking Agents; Pancuronium; Vecuronium Bromide

Topics: Anesthesia, Intravenous; Aorta; Dopamine; Female; Fentanyl; Fluid Therapy; Heart Arrest; Heart Defects, Congenital; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Intraoperative Complications; Ligation; Monitoring, Physiologic; Pancuronium; Patient Care Planning; Pulmonary Artery; Pulmonary Veins; Twins, Conjoined; Venae Cavae

Topics: Female; Heart Arrest; Humans; Intraoperative Complications; Middle Aged; Neuromuscular Blocking Agents; Pancuronium; Sinoatrial Node; Vecuronium Bromide

The existence of treatable postischemic (PI) changes which influence neurological outcome has been documented by this group before. A global brain ischemia model without cardiac arrest was developed in monkeys. It includes high-pressure neck tourniquet inflation plus hypotension for a reproducible ischemic insult; survival with reproducible neurological deficit (ND) under continuous PI life-support for 7 days with control of extracranial variables; and new ND and histopathological damage scoring systems. Hypoxemia, hypercarbia, hypotension, uremia, sepsis, and other extracranial complications PI in 50 unsatisfactory experiments led to immediate worsening in ND and brain death (ND = 100%) in most of these monkeys. In contrast, all monkeys with the same initial insult, with life-support according to protocol, survived with a 7 day ND of 60% or less. In 46 experiments of seven treatment groups, after 16 or 18 min ischemia, life support was according to protocol for 7 days. The control 1 protocol (spontaneous breathing when feasible) resulted in a mean 7-day ND score of 53% (including quadriplegia). Immobilization with pancuronium and controlled ventilation ameliorate deficit to an ND score of 19% (P less than 0.05) (including quadriparesis); this became control 2 protocol. Immobilization resulted in less neuronal damage in the neocortex. Severe repetitive hypertension worsened ND to 46%, versus 19% in controls (P less than 0.05). In separate series, neither heparinization over 72 hours PI, nor hemodilution to hematocrit 25% with dextran 40, changed final ND significantly from that of their control groups. Histopathological damage scores correlated with ND scores.

Topics: Animals; Haplorhini; Heart Arrest; Hypercapnia; Hypotension; Hypoxia; Ischemic Attack, Transient; Nervous System Diseases; Pancuronium; Respiration, Artificial; Sepsis; Uremia

Topics: Heart Arrest; Homicide; Hospitals, Veterans; Humans; Medication Errors; Michigan; Pancuronium; Poisoning

Topics: Adult; Anesthesia; Arteriovenous Fistula; Atropine; Carotid Artery Diseases; Cavernous Sinus; Dexamethasone; Diazepam; Droperidol; Female; Fentanyl; Heart Arrest; Humans; Hypothermia, Induced; Naloxone; Neostigmine; Neuroleptanalgesia; Pancuronium; Preanesthetic Medication; Thiopental

Over a six-week period, a striking increase in the incidence of cardiopulmonary arrests occurred at the Ann Arbor Veterans Administration Hospital, Criminal administration of a muscle-paralyzing agent was implicated. An epidemiologic investigation les to a description of the classic features of an epidemic; time, place, person, agent and mode of transmission. Control of the agent and susceptible patients led to cessation of the epidemic. Although the perpetrator was not specifically identified, the concurrent criminal investigation was aided by the data developed in the medical investigation. On the basis of this experience, we propose a surveilliance mechanism for early detection of increased critical incidents, such as cardiopulmonary arrests, and a scheme for systematically examining similar events.

Topics: Disease Outbreaks; Forensic Medicine; Heart Arrest; Homicide; Humans; Injections, Intravenous; Michigan; Middle Aged; Pancuronium; United States; United States Department of Veterans Affairs

This paper presents the findings made on the rate of mortality following tumour resections in the head and neck achieved in the Clinic for Maxillo-Facial and Plastic Surgery of the Face, University of Dusseldorf, from 1953 to 1973. The relationship between rate of mortality and improved measures taken before, during and after the operation are also discussed.

Topics: Barbiturates; Blood Transfusion; Bronchopneumonia; Embolism; Halothane; Head; Head and Neck Neoplasms; Heart Arrest; Humans; Infusions, Parenteral; Lung Diseases; Neoplasms; Nitrous Oxide; Pancuronium; Postoperative Care; Postoperative Complications; Preoperative Care

Topics: Acidosis; Anemia; Anesthesia, Epidural; Anesthesia, General; Carbon Dioxide; Gallamine Triethiodide; Halothane; Heart Arrest; Humans; Hyperkalemia; Kidney Transplantation; Magnesium; Methoxyflurane; Nitrous Oxide; Oxygen; Pancuronium; Potassium; Renal Dialysis; Transplantation, Homologous; Tubocurarine; Urea