pancuronium and Hypotension

Topics: Ambulatory Care; Anesthesia; Anesthetics; Body Temperature Regulation; Child; Ethane; Halogens; Humans; Humidity; Hypotension; Infant, Newborn; Ketamine; Malignant Hyperthermia; Methoxyflurane; Monitoring, Physiologic; Pancuronium; Succinylcholine; Tubocurarine

Topics: Aged; Androstane-3,17-diol; Androstanols; Bradycardia; Clinical Trials as Topic; Coronary Artery Bypass; Humans; Hypotension; Middle Aged; Neuromuscular Blocking Agents; Pancuronium; Pipecuronium; Piperazines; Random Allocation

The effects of prophylactic infusion of 1 microgram X kg-1 X min-1 nitroglycerin (NTG) on the incidence of ischemia, hypertension, hypotension and perioperative myocardial infarction were studied in 81 patients during coronary artery bypass grafting (CABG). Forty-one patients (Group 1) received NTG and 40 patients (Group 2) received placebo. All patients received fentanyl for anesthesia and pancuronium. Mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), heart rate (HR), and cardiac output (CO) were measured before and after induction of anesthesia, after intubation, before and after chest incision, after sternotomy, after the pericardium was opened, and during normothermic cardiopulmonary bypass. Myocardial ischemia and infarction were diagnosed from the ECG, hypertension was defined as a 20% increase in MAP, and hypotension was defined as a 20% decrease in MAP compared with preinduction values. No significant differences between Groups 1 and 2 in HR, PCWP, or CO were seen. MAP was significantly lower in Group 1 than Group 2 (P less than 0.05) before chest incision, but increased to levels equal to Group 2 after sternotomy. Hypertension occurred in 32 Group 2 patients and 25 Group 1 patients (0.05 less than P less than 0.1). Group 1 patients had 0.95 +/- 0.14 episodes per patient of hypertension, while Group 2 patients had 2.10 +/- 0.31 episodes (P less than 0.05). Hypotension occurred in 20 Group 1 patients but only six Group 2 patients (P less than 0.05). There was no difference in the incidence of ischemia. In Group 1, nine patients (22%) had ECG changes of ischemia, while 12 patients in Group 2 (30%) had ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anesthesia; Cardiac Output; Coronary Artery Bypass; Coronary Disease; Creatine Kinase; Electrocardiography; Fentanyl; Heart Rate; Humans; Hypertension; Hypotension; Nitroglycerin; Pancuronium; Pulmonary Wedge Pressure; Tachycardia

Topics: Aged; Anaphylaxis; Anesthesia, Intravenous; Anesthetics, Intravenous; Bronchial Spasm; Humans; Hypotension; Male; Neuromuscular Nondepolarizing Agents; Pancuronium; Propofol; Tachycardia; Thiopental

Plasma vasopressin (AVP) levels were measured at rest (mean arterial pressure 80-85 mmHg) and during hypotension (mean arterial pressure 38-45 mmHg) induced by ganglionic blockade (trimethaphan) in halothane-anaesthetized respirated rats with end-tidal pCO2 maintained at 34-40 mmHg. Hypotension (15 min) produced a 310% increase in plasma AVP (+/- 60% S.E.M.) which was not reduced significantly by prior baro- and chemoreceptor denervation. The hypotension-induced rise in AVP was blocked by bilateral microinjections (40 nl) of the GABA-mimetic agent muscimol (151 pmol) into the ventrolateral medulla at obex level and significantly attenuated by injections of the same amount in the nucleus tractus solitarius. The rise in AVP was unaffected by microinjections in the pontine locus coeruleus. It was also blocked by bilateral microinjections of the glutamate-receptor antagonist kynurenate (40 nl, 1.8 nmol) into the ventrolateral medulla but unaffected by microinjections of the inactive analogue xanthurenic acid (40 nl, 1.8 nmol). A significantly smaller rise in plasma AVP (88%) was observed following bilateral nephrectomy. It is concluded that, in this preparation, hypotension produces the release of AVP via a mechanism largely independent of baro- and chemoreceptors, which requires the activation of neurones located in the caudal medulla oblongata. The same or closely related neurones may be activated by a neural or hormonal signal generated by the kidney.

Topics: Animals; Arginine Vasopressin; Chemoreceptor Cells; Hypotension; Kynurenic Acid; Male; Medulla Oblongata; Muscimol; Nephrectomy; Pancuronium; Phenylephrine; Pressoreceptors; Rats; Rats, Inbred Strains; Receptors, Glutamate; Receptors, Neurotransmitter; Trimethaphan

A 78-year-old woman admitted for an elective hip operation was maintained on atenolol for control of her hypertension. She received neostigmine and atropine for reversal of muscle relaxation at the end of general anaesthesia. She then developed prolonged bradycardia and hypotension which necessitated the use of adrenaline and isoprenaline. Such an adverse reaction with atenolol has not been described previously.

Topics: Aged; Atenolol; Bradycardia; Drug Interactions; Female; Humans; Hypotension; Neostigmine; Pancuronium; Postoperative Complications

The intubating conditions, time to complete block and duration of clinical relaxation were observed in a group of 101 elderly patients (aged over 65 years) following pancuronium 0.1 mg kg-1, vecuronium 0.1 mg kg-1 or atracurium 0.5 mg kg-1. The intubating conditions in the three groups were similar when assessed at 2 min following relaxant administration. The time to complete block was shortest with vecuronium (4.3 min) in comparison to atracurium (5.0 min) and pancuronium (6.0 min), but the differences were not statistically significant. The duration of clinical relaxation, however, was significantly shorter with vecuronium (37 min) and atracurium (35 min) in comparison to pancuronium (99 min).

Topics: Aged; Atracurium; Drug Eruptions; Humans; Hypotension; Isoquinolines; Neuromuscular Blocking Agents; Pancuronium; Surgical Procedures, Operative; Time Factors; Vecuronium Bromide

Topics: Humans; Hypotension; Infant, Newborn; Infant, Premature; Pancuronium

The anaesthetic requirements for tracheal resection include a clear airway, adequate ventilation and good surgical access. Many techniques have been described, none of which is entirely satisfactory. This case reports on the use of high-frequency jet ventilation with 10Fg catheter combined with muscle relaxants and intravenous anaesthesia in a patient with tracheal stenosis.

Topics: Aged; Anesthesia, Intravenous; Carbon Dioxide; Humans; Hypotension; Intraoperative Complications; Male; Pancuronium; Partial Pressure; Respiration, Artificial; Tracheal Stenosis

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: Bronchial Spasm; Cyanosis; Histamine Release; Humans; Hypotension; Male; Middle Aged; Pancuronium; Pulmonary Edema

Topics: Anesthesia, Dental; Anesthesia, General; Dihydroxyphenylalanine; Female; Halothane; Humans; Hypertension; Hypotension; Middle Aged; Pancuronium; Parkinson Disease; Postoperative Complications

Topics: Anesthesia; Arrhythmias, Cardiac; Body Weight; Bronchial Spasm; Female; Histamine Release; Humans; Hypotension; Infant; Infant, Newborn; Injections, Intramuscular; Male; Muscle Relaxants, Central; Neuromuscular Depolarizing Agents; Pancuronium; Postoperative Complications; Respiratory Insufficiency; Succinylcholine; Time Factors; Tubocurarine

Topics: Adolescent; Adult; Aged; Anesthesia, General; Anesthetics; Arrhythmias, Cardiac; Blood Pressure; Carbon Dioxide; Cardiac Surgical Procedures; Child; Female; Gallamine Triethiodide; Heart Rate; Humans; Hypotension; Intubation, Intratracheal; Male; Methohexital; Middle Aged; Neuromuscular Nondepolarizing Agents; Oxygen; Pancuronium; Thiopental; Toxiferine; Tubocurarine

Topics: Acid-Base Equilibrium; Aged; Anesthesia, General; Aorta, Abdominal; Blood; Blood Transfusion; Blood Vessel Prosthesis; Carbon Dioxide; Cardiac Output; Humans; Hydrogen-Ion Concentration; Hypotension; Hypothermia; Iliac Artery; Middle Aged; Nitrous Oxide; Oxygen; Pancuronium; Respiration, Artificial; Thrombosis; Vascular Surgical Procedures