pancuronium and Hyperkalemia

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

Topics: Anesthesia, Inhalation; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Cholinesterase Inhibitors; Drug Antagonism; Drug Synergism; Humans; Hydrogen-Ion Concentration; Hyperkalemia; Myasthenia Gravis; Neostigmine; Neuromuscular Blocking Agents; Neuromuscular Depolarizing Agents; Neuromuscular Junction; Pancuronium; Pyridostigmine Bromide; Succinylcholine; Water-Electrolyte Balance

Five different non-depolarizing muscle relaxants and a control solution of saline were studied as precurarization agents. Two hundred and twenty-two surgical patients (ASA I-II) were allocated in a double-blind fashion to one of the following groups: d-tubocurarine 0.05 mg/kg, alcuronium 0.03 mg/kg, pancuronium 0.01 mg/kg, gallamine 0.25 mg/kg, ORG NC-45 (vecuronium) 0.01 mg/kg and saline solution 0.005 ml/kg. Pretreatment was performed 4 min before administering a 1.5 mg/kg bolus of succinylcholine (SCh). Fasciculations, intubation conditions, duration of neuromuscular blockade after SCh, serum potassium changes and postoperative myalgias (in 60 patients) were recorded. All the drugs studied prevented fasciculations significantly (P less than 0.05) more than in the control group. d-Tubocurarine and alcuronium were superior to the others in this respect. Intubation conditions were best in the control and pancuronium groups, but there was no significant difference between the pancuronium and d-tubocurarine or between the d-tubocurarine and alcuronium groups. Pancuronium pretreatment prolonged the SCh block significantly, whereas other agents shortened the duration of the SCh block. The antagonism of the SCh block apparently also affected intubation conditions, although intubation remained satisfactory. A statistically significant rise in serum potassium level was measured only in the control and pancuronium groups. In the control and pancuronium groups, four patients out of 10 had postoperative myalgias, whereas in the other groups only one or none out of 10 had them (0/10 vs. 4/10; 0.10 greater than P greater than 0.05). In conclusion, d-tubocurarine and alcuronium seem to have advantages over pancuronium, ORG NC-45 and gallamine for precurarization.

Topics: Adolescent; Adult; Alcuronium; Anesthesia, General; Clinical Trials as Topic; Double-Blind Method; Female; Gallamine Triethiodide; Humans; Hyperkalemia; Male; Middle Aged; Muscle Contraction; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Pancuronium; Preanesthetic Medication; Succinylcholine; Toxiferine; Tubocurarine; Vecuronium Bromide

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; Female; Humans; Hyperkalemia; Middle Aged; Neuromuscular Junction; Pancuronium; Potassium; Premedication; Succinylcholine

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