pancuronium and Hemiplegia

Neuromuscular blockade induced by pancuronium was monitored on the trapezius and abductor digiti minimi muscles in three patients with upper motor neurone lesions: one patient was hemiparetic and two were tetraparetic. A greater sensitivity to pancuronium was always observed on the trapezius muscle. It is suggested that the assessment of curarisation is more reliable on proximal than on distal muscles if the patient's sensitivity to relaxants is expected to be generally low.

Topics: Adult; Child; Female; Fingers; Hemiplegia; Humans; Male; Monitoring, Physiologic; Motor Neurons; Muscle Contraction; Neuromuscular Diseases; Neuromuscular Junction; Pancuronium; Quadriplegia; Shoulder; Synaptic Transmission

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

The purpose of this study was to examine differences in train-of-four (TOF) ratios between paretic and healthy extremities after pancuronium and neostigmine administration in 31 patients with hemiparesis. The TOF ratios on the paretic side after pancuronium administration were greater than those on the healthy side in all patients. Patients were classified according to the size of the difference in the TOF ratio on both sides. In group 1, differences in TOF ratios were greater than 20%, and in group 2, they were less than 20%. Fifteen of 17 patients in group 1 had hemiparesis for over three weeks, and in group 2, 10 of 14 patients had hemiparesis for less than three weeks. Patients with flaccid hemiparesis were distributed equally in both groups, while all patients with spastic hemiparesis belonged to group 1. The difference in increase in TOF ratios after neostigmine was the same as the difference in decrease produced by pancuronium.

Topics: Adult; Aged; Electric Stimulation; Female; Hemiplegia; Humans; Male; Middle Aged; Muscle Contraction; Neostigmine; Pancuronium; Thumb; Ulnar Nerve