pancuronium and Hypercapnia

It was hypothesized that non-depolarizing neuromuscular blocking agents impair hypoxic chemosensitivity in man.. In thirty randomly allocated male volunteers the hypoxic and hypercarbic ventilatory responses were measured during partial paralysis (TOF ratio 0.70) due to either atracurium (n = 10), pancuronium (n = 10) or vecuronium (n = 10).. Hypoxic ventilatory responses were depressed by 306, 287 and 296% (mean SD) at steady-state infusion of atracurium, pancuronium and vecuronium, respectively. At a TOF ratio of > 0.90, the HVR was not different from control measurements.. It is concluded that non-depolarizing neuromuscular blocking agents impair hypoxic ventilatory regulation. Further experimental studies are warranted to fully describe the mechanism(s) responsible for this interaction.

Topics: Atracurium; Chemoreceptor Cells; Humans; Hypercapnia; Hypoxia; Male; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pancuronium; Respiration; Vecuronium Bromide

Spontaneous electrical activity of extrathoracic trachea was recorded along with force developed by tracheal smooth muscle and phrenic nerve activity in decerebrated, paralyzed, and artificially ventilated dogs with pneumothorax. The tracheal electrical activity exhibited slow oscillating potentials that were coupled with spontaneous phasic contraction of trachea. Both rhythmic changes were synchronous with central respiratory rhythm represented by phrenic burst, independent of the respirator's rhythm. The dominant component of the slow oscillating potentials consisted of sinusoidal waves with large amplitude that occurred shortly after cessation of phrenic burst, i.e., in the postinspiratory phase. The concomitant small change in the slow oscillating potentials began in the late inspiratory phase just before the initiation of the tracheal contraction. This phase relationship was preserved after removal of intrathoracic vagal afferents from lungs. Such slow oscillating potentials were also observed during lung collapse produced by disconnecting the tube attached to the respirator. Transection of recurrent laryngeal nerves abolished the slow oscillating potentials. These results indicate that the slow oscillating potentials of the extrathoracic trachea are generated by a physiological process associated with the central respiratory rhythm. The dominant component of the slow oscillating potentials occurs in the postinspiratory phase.

Topics: Anesthesia; Animals; Carbon Dioxide; Dogs; Electric Stimulation; Electrodes, Implanted; Electrophysiology; Evoked Potentials; Hypercapnia; Laryngeal Nerves; Muscle Contraction; Muscle, Smooth; Neurons, Afferent; Oxygen Consumption; Pancuronium; Phrenic Nerve; Pulmonary Atelectasis; Respiration, Artificial; Trachea

The effect of hypercarbia on ocular blood flow was studied in the newborn piglet with the isotope-labeled microsphere method. Blood flow measurements were made during spontaneous breathing and during paralyzation (pancuronium) and mechanical ventilation. Retinal blood flow increased from 0.40 +/- 0.07 (mean +/- SEM) ml/min/g at baseline levels to 0.91 +/- 0.17 ml/min/g at a PaCO2 level of 11.0 kPa during spontaneous ventilation. A similar response was observed during paralyzation and mechanical ventilation (0.89 +/- 0.15 ml/min/g at a PaCO2 of 11.1 kPa). For choroidal blood flow, however, the increase caused by hypercarbia during spontaneous ventilation (16.14 +/- 3.69 to 29.15 +/- 3.22 ml/min/g) was significantly reduced when the animals were paralyzed and mechanically ventilated (15.99 +/- 2.99 to 23.51 +/- 3.41 ml/min/g). Since choroidal blood flow accounts for 60-80% of oxygen delivery to the retina, paralyzation and mechanical ventilation may significantly reduce oxygen delivery to the retina during hypercarbia.

Topics: Animals; Animals, Newborn; Choroid; Eye; Humans; Hypercapnia; Infant, Newborn; Organ Size; Pancuronium; Paralysis; Regional Blood Flow; Respiration; Respiration, Artificial; Retinal Vessels; Retinopathy of Prematurity; Swine

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

Changes in myocardial performance after administration of gallamine 1.5 mg kg-1 and pancuronium 0.1 mg kg-1 were investigated in hypercapnic (PaCO2 = 7.08 kPa) and hypocapnic (PaCO2 = 2.74 kPa) dogs anaesthetized with thiopentone, nitrous oxide and halothane. Administration of pancuronium during hypocapnia caused a decrease of 25% in dP/dt max (corrected for changes in preload, afterload and heart rate). This change was not seen during hypercapnia, probably because of the associated sympathetic stimulation. By contrast, gallamine was without effect on dP/dt max in both groups. The increase in heart rate and cardiac output caused by the atropine-like action of both groups. The increase in heart rate and cardiac output caused by the atropine-like action of these relaxant drugs differed in the hypercapnic and hypocapnic group of dogs, with the more pronounced response in the latter group. The duration of the chronotropic changes was the same in both groups.

Topics: Animals; Carbon Dioxide; Dogs; Gallamine Triethiodide; Heart; Hemodynamics; Hypercapnia; Pancuronium