pancuronium and Infant--Newborn--Diseases

Topics: Animals; Animals, Newborn; Blood Pressure; Bronchi; Cerebrovascular Circulation; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pancuronium; Respiration, Artificial; Sheep

Topics: Education, Nursing, Continuing; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pancuronium; Patient Care Planning; Respiration, Artificial

In experimental animals neurologic damage may occur during seizure activity whether the seizure is accompanied by motor activity and hypoxemia or whether the animal is paralyzed and normoxemic. These findings suggest that it may be important to detect seizure activity in the paralyzed neonate. Nine infants who were mechanically ventilated and paralyzed with pancuronium had their condition diagnosed as seizure activity. Vital signs were continuously monitored and six infants had either oxygen saturation or transcutaneous oxygen measured during seizure activity. For the group as a whole, rhythmic fluctuations in vital signs, cardiac rhythm, and oxygenation occurred every four minutes (range one to seven minutes) and lasted two minutes (range one to four minutes). In seven patients whose seizures were not accompanied by cardiac arrhythmias the following mean increases were noted: systolic arterial blood pressure, 15 mm Hg (range 7 to 36 mm Hg); heart rate, ten beats per minute (-11 to 30/min); oxygen saturation, 12% (range 4% to 20%); and transcutaneous oxygen, 31 mm Hg (range 14 to 45 mm Hg). Seizures in the two patients with cardiac arrhythmias were accompanied by a decrease in systolic arterial blood pressure of 27 mm Hg (range 15 to 40 mm Hg) and in oxygen saturation of 24% (range 20% to 28%). The presence of rhythmic fluctuation in vital signs and oxygenation should alert the physician to the possibility of seizure activity in the paralyzed neonate.

Topics: Anesthesia, General; Blood Pressure; Electrocardiography; Electroencephalography; Humans; Infant, Newborn; Infant, Newborn, Diseases; Monitoring, Physiologic; Oxygen; Pancuronium; Seizures

Neuromuscular blockade with pancuronium and its antagonism was evaluated in 33 critically ill infants. The evoked contraction of the adductor pollicis from indirect stimulation of the ulnar nerve was measured. The neuromuscular blockade recovered spontaneously from pancuronium in seven infants, 23 required one or more doses of atropine 0.02 ng kg-1 and neostigmine 0.06 mgkg-1. In three infants the blockade failed to reverse. Immature infants less than 32 weeks did not show any significant different in their requirement for pancuronium compared with mature infants. Age and birth weight of the infant, dose of pancuronium and duration of its administration did not affect the requirements for reversal. Train-of-four and tetanus; twitch ratios were lower (P less than 0.05) in infants less than 32 weeks of developmental age reflecting immaturity of neuromuscular transmission.

Topics: Critical Care; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Muscle Contraction; Neuromuscular Junction; Pancuronium; Respiration, Artificial; Synaptic Transmission

Pancuronium bromide treatment in severely ill, mechanically ventilated infants has been shown to result in lower peak transpulmonary pressure, with an accompanying lower-than-expected incidence of pneumothorax. Infants, treated with pancuronium often demonstrate an ominous abdominal roentgenographic finding: the "gasless abdomen." Of 38 mechanically ventilated infants, 22 of 24 pancuronium-treated infants (as compared with four of 14 untreated infants) had diminished or absent bowel gas. There was no significant difference between the two groups with regard to birth weight, mortality, or incidence of respiratory distress syndrome. Pancuronium prevents swallowing of air but does not inhibit gut peristalsis, thus accounting for the evacuation of abdominal gas three hours or more after administration of the drug. Clinicians who treat infants with pancuronium should be aware of the phenomenon, to avoid needless roentgenographic studies.

Topics: Gases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestines; Male; Pancuronium; Peristalsis; Radiography, Abdominal; Respiration Disorders; Respiration, Artificial; Respiratory Distress Syndrome, Newborn

Topics: Humans; Hypoventilation; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Oxygen; Pancuronium; Respiration Disorders; Respiration, Artificial

Five infants with neonatal tetanus were managed with neuromuscular blockade and positive pressure ventilation. All survived. Tetanus was frequently confused with neonatal seizures at time of presentation. All infants were delivered at home. Mean age of onset of symptoms of poor suck, hypertonicity, and generalized spasms was 5.4 days with hospital admission at 6.4 days. Mean duration of mechanical ventilation was 34 days. Although hospital management of tetanus neonatorum may be expected to have a satisfactory outcome, it represents a costly and complex approach to a preventable disease.

Topics: Female; Humans; Hypnotics and Sedatives; Infant, Newborn; Infant, Newborn, Diseases; Intermittent Positive-Pressure Ventilation; Male; Pancuronium; Tetanus; Tetanus Antitoxin

We evaluated the effect of muscle paralysis on gas exchange and incidence of pneumothorax in 35 severely ill infants on mechanical ventilation. Pancuronium (0.1 mg/kg) was given repeatedly until spontaneous respirations ceased in infants with inadequate gas exchange with FIO2 greater than 0.60, or peak inspiratory pressure greater than 30 cm H2O, or who were breathing out of phase with the respirator. Of 27 infants who had an alveolar-arterial oxygen gradient greater than 300 torr before paralysis, AaDO2 improved by greater than 100 torr within one hour of paralysis in only two infants; it worsened in two infants within the same period. By six hours postparalysis, 12 of 27 infants had improved, five of whom had had a worsening AaDO2 before administration of pancuronium. Changes in oxygenation were unrelated to changes in arterial carbon dioxide tension in most infants. Peak transpulmonary pressures after paralysis were lower than during spontaneous breathing, and may explain the low incidence of pneumothorax (3 of 35) during paralysis. Since those who improved could not be distinguished by birth weight, gestational age, or diagnosis, pancuronium might be worthy of trial in a mechanically ventilated infant with severe lung disease who is at risk for pneumothorax.

Topics: Carbon Dioxide; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lung Diseases; Muscle Contraction; Muscle Relaxation; Oxygen; Pancuronium; Pneumothorax; Respiration, Artificial

We have attempted to present a brief overview of current considerations in anesthesia for surgery of gastrointestinal disease as practiced at our institution. Many considerations remain unexplored owing to limitations of space. We have deliberately concentrated upon antecedent and concurrent therapy encountered in the treatment of the surgical patient. The potent drugs introduced in the past decade have produced infinite potential for drug interactions--some serious, some not so serious, and some which are desirable. We hope we have generated further reader interest in this mushrooming problem of modern medicine confronting the anesthesiologist and surgeon in the perioperative period.

Topics: Aged; Anesthetics; Drug Interactions; Enflurane; Female; Gastrointestinal Diseases; Halothane; Humans; Hypertension; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intussusception; Ketamine; Lung Diseases; Obesity; Pancuronium; Pregnancy; Pyloric Stenosis