pancuronium and Hyperventilation

An awake patient presented with central neurogenic hyperventilation induced by a cerebral tumor. Corticosteroid therapy and brain irradiation while the patient was anesthetized and respiration controlled under pancuronium-induced respiratory paralysis were followed by tumor regression and resolution of hyperventilation. Recurrence of tumor 6 weeks later was not accompanied by recurrence of hyperventilation. Cytologic study of cerebrospinal fluid revealed B-cell lymphoma. This patient brings to 10 the number of cases recorded with tumor-induced central neurogenic hyperventilation. Five of the eight patients with known tumor histology had a primary cerebral lymphoma, a rare neoplasm that comprises only 1% of all intracranial neoplasms. The disproportionately high frequency of central neurogenic hyperventilation in patients with cerebral lymphoma has therapeutic implications that are briefly reviewed.

Topics: Adrenal Cortex Hormones; Brain; Brain Neoplasms; Combined Modality Therapy; Diaphragm; Female; Humans; Hyperventilation; Lymphoma; Middle Aged; Pancuronium; Tomography, X-Ray Computed

The effect of hypocarbia on the recovery from the neuromuscular blockade produced by vecuronium was studied in 20 anesthetized patients. Vecuronium was administered until twitch tension was reduced to between 0-15% of control. Neuromuscular function was then allowed to spontaneously recover during continued normocarbia (end-tidal PCO2 5.5 kPa [41 mm Hg]) in half the patients, and in the other half of the patients hyperventilation producing hypocarbia (mean end-tidal PCO2 of 3.1 +/- 0.4 kPa SD [23 +/- 3 mm Hg] at the completion of twitch force recovery) was initiated at the beginning of spontaneous recovery from neuromuscular blockade. The mean vecuronium recovery index (time for spontaneous recovery from 25-75% of control twitch tension) was slightly but not significantly shorter in the hyperventilated patients (8.4 +/- 1.8 min SD) than in the normally ventilated patients (10.4 +/- 3.4 min SD). We conclude the vecuronium recovery index in anesthetized patients is not significantly changed by hyperventilation with hypocarbia when induced at the beginning of recovery from neuromuscular blockade.

Topics: Adult; Carbon Dioxide; Female; Humans; Hyperventilation; Male; Neuromuscular Junction; Pancuronium; Pulmonary Gas Exchange; Vecuronium Bromide

Conray (meglumine iothalamate), the contrast media frequently used in shuntograms for diagnosing malfunctioning ventriculo-peritoneal shunts, will occasionally cause severe muscular spasms and seizures. In this article, the authors describe anesthetic and critical care management of a case with this complication.

Topics: Anesthesia, Inhalation; Anesthesia, Intravenous; Cerebrospinal Fluid Shunts; Child; Diazepam; Female; Humans; Hyperventilation; Iothalamate Meglumine; Muscle Spasticity; Pancuronium; Positive-Pressure Respiration; Seizures; Thiopental

Topics: Anesthetics; Carbon Dioxide; Diaphragm; Drug Synergism; Halothane; Humans; Hyperventilation; Male; Middle Aged; Muscle Contraction; Muscle Proteins; Muscle Relaxants, Central; Muscle Tonus; Muscles; Neuromuscular Blocking Agents; Pancuronium; Partial Pressure; Succinylcholine; Tubocurarine