pancuronium and Infant--Premature--Diseases

Topics: Cerebral Hemorrhage; Cerebrovascular Circulation; Clinical Trials as Topic; Ethamsylate; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Pancuronium; Phenobarbital; Risk; Vitamin E

Topics: Cerebral Hemorrhage; Cerebrovascular Circulation; Clinical Trials as Topic; Ethamsylate; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Pancuronium; Phenobarbital; Risk; Vitamin E

Topics: Cerebral Hemorrhage; Clinical Trials as Topic; Humans; Infant, Newborn; Infant, Premature, Diseases; Pancuronium; Respiration, Artificial; Respiratory Distress Syndrome, Newborn

Preterm infants who were making expiratory efforts against ventilator inflation were randomised to be paralysed with pancuronium or to receive no paralysing agent during ventilation. Pneumothoraces developed in all 11 unparalysed babies but in only 1 of 11 (p less than 0.0004) of those managed with pancuronium, which had no serious side-effects. In 34 infants excluded from the trial because they were not breathing against the ventilator, no pneumothoraces developed.

Topics: Clinical Trials as Topic; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Intubation, Intratracheal; Lung; Male; Pancuronium; Pneumothorax; Random Allocation; Respiration; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Tidal Volume

To assess the effects of muscle relaxation on the critically ill ventilated neonate, pancuronium bromide was administered for a 12-hour period to ten low-birth-weight neonates (960 to 2,000 gm) of 26 to 34 weeks gestation, all whom required mechanical ventilation and were studied within 48 hours of birth (six to 39 hours). The infants were also studied for a 12-hour period during which no pancuronium bromide was administered. During both study periods, the order of which was randomized, heart rate, blood pressure, PO2, and intracranial pressure were continuously measured. The amounts of handling during the pancuronium and control periods were similar. The results revealed a significantly greater duration of hypoxia (PO2 less than 50 torr) (56.1 vs 23.6 minutes, P less than .001) and hyperoxia (PO2 greater than 70 torr) during the control period (92.5 vs 13 minutes, P less than .001). Durations of intracranial pressure elevation 10 cm H2O above the infant's baseline were significantly less during paralysis (6.7 vs 58.8 minutes, P less than .001) as were spikes of intracranial pressure to greater than 25 cm H2O (1.6 vs 24.4, P less than .05). There was no significant improvement in blood gas values, fractional inspiratory oxygen, or ventilator settings during muscle relaxation. Pancuronium reduced periods of nonoptimal oxygenation and elevated intracranial pressure and may therefore help to decrease adverse sequelae for the low-birth-weight, ventilated neonate.

Topics: Catheters, Indwelling; Clinical Trials as Topic; Evaluation Studies as Topic; Female; Heart Rate; Humans; Hypoxia; Infant, Newborn; Infant, Premature, Diseases; Intracranial Pressure; Male; Monitoring, Physiologic; Muscle Contraction; Muscle Relaxation; Pancuronium; Respiration, Artificial; Respiratory Distress Syndrome, Newborn

A fatal case of fulminant hepatic failure that occurred in the neonatal period is reported in a premature infant born after 27 4/7-weeks' gestation. Immediately after birth the infant had severe hypoxia and hypotension resulting from birth asphyxia, hypovolemic shock, and septicemia. At autopsy, histological appearance of the liver showed virtually total hepatocellular necrosis without features of fibrosis. Although the exact cause of hepatocellular injury cannot be fully ascertained, it is assumed that hypoxia and hypotension must have been the predominant factors leading to massive hepatic necrosis.

Topics: Acyclovir; Alanine Transaminase; Aspartate Aminotransferases; Bicarbonates; Cloxacillin; Dopamine; Female; Fetal Hypoxia; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infant, Premature, Diseases; Liver; Male; Necrosis; Netilmicin; Pancuronium; Partial Thromboplastin Time; Penicillins; Pregnancy; Prothrombin Time; Sepsis; Shock; Sodium; Sodium Bicarbonate

Blood pressure (BP) fluctuations in infants with respiratory distress syndrome (RDS) are related to spontaneous respirations and have been associated with an increased incidence of intraventricular hemorrhage. Both initiation of mechanical ventilation in the nonventilated infant and muscle paralysis in the ventilated infant can help stabilize these fluctuations. We hypothesized that narcotic sedation would also be effective in decreasing BP fluctuations when pharmacologic intervention is deemed necessary. Twenty premature infants were paralyzed with pancuronium or sedated with morphine or fentanyl for clinical indications. Blood pressure and respiratory tracings before and after medication were analyzed for average peak systolic BP (SBP) and the percentage of spontaneous respirations (SResp). Fluctuations of SBP were quantitated using the coefficient of variation (CV). A marked reduction was found in both CV and SResp following administration of all three drugs. Peak inspiratory pressure and ventilator rate were increased in the pancuronium group. In 7 out of 14 patients in whom spontaneous respirations persisted following sedation, there was a strong association between the percentage of decrease in CV and SResp. Advantages of narcotic sedation over muscle paralysis are discussed.

Topics: Blood Pressure; Conscious Sedation; Fentanyl; Humans; Infant, Newborn; Infant, Premature, Diseases; Morphine; Pancuronium; Prospective Studies; Respiration; Respiratory Distress Syndrome, Newborn

Topics: Blood Flow Velocity; Blood Pressure; Cerebral Hemorrhage; Cerebrovascular Circulation; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Pancuronium

Topics: Cyanosis; Humans; Infant, Newborn; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Pancuronium; Pulmonary Emphysema

A retrospective study was conducted on 37 ventilated newborn infants to find out whether muscle paralysis by pancuronium had prevented pneumothorax (pt) in those severely ill newborn infants. In the group of 21 newborns who developed pt, 17 (81%) had been paralyzed with pancuronium. In the group of 16 newborns without pt, 10 (61%) had received pancuronium (chi 2 = 1,568, ns). Thus, muscular paralysis had not prevented pt. Since the newborns in both groups were equally severely ill (mean compliance of the respiratory system 0.48 +/- 0.17 ml/cm H20 in the group with pt, 0.38 +/- 0.12 in the group without pt), we assume that pancuronium was unable to prevent pt in ventilated premature and full-term newborn infants. We therefore caution against the use of pancuronium as a paralytic drug known to have deleterious side effects.

Topics: Humans; Infant, Newborn; Infant, Premature, Diseases; Intermittent Positive-Pressure Breathing; Lung Compliance; Pancuronium; Pneumothorax; Positive-Pressure Respiration; Prognosis; Respiratory Distress Syndrome, Newborn

Topics: Anesthesia; Cardiac Tamponade; Ductus Arteriosus, Patent; Fentanyl; Humans; Infant, Newborn; Infant, Premature, Diseases; Intraoperative Complications; Ligation; Male; Pancuronium; Pneumopericardium; Respiration, Artificial

A bolus of 30 micrograms X kg-1 fentanyl was given to nine preterm infants (gestational age 31.8 +/- 4.7 weeks, weight 1100 +/- 309 g) for induction of anesthesia for ligation of a patent ductus arteriosus. Thirty minutes after the injection, fentanyl plasma concentrations were between 7.7 and 13.6 ng X ml-1. Elimination half-life was 6-32 hr (mean +/- SD, 17.7 +/- 9.3). Systolic blood pressure remained stable throughout surgery. There was a gradual increase in heart rate from 159 +/- 12 min-1 at the time of skin incision to 173 +/- 15 min-1 at the time of skin closure (P less than 0.05). Fentanyl plasma concentrations remained virtually unchanged between 30 min (10.6 +/- 1.9 ng X ml-1) and 120 min (9.6 +/- 1.6 ng X ml-1); whereas at the end of surgery most infants moved and breathed spontaneously. This phenomenon can be explained by redistribution of fentanyl from brain into pharmacodynamically inert tissues.

Topics: Anesthesia, Intravenous; Blood Pressure; Ductus Arteriosus, Patent; Female; Fentanyl; Heart Rate; Hemodynamics; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Kinetics; Ligation; Male; Pancuronium

Topics: Blood Flow Velocity; Cerebral Hemorrhage; Cerebral Ventricles; Cerebrovascular Circulation; Humans; Infant, Newborn; Infant, Premature, Diseases; Pancuronium; Respiratory Distress Syndrome, Newborn

Topics: Cerebral Hemorrhage; Humans; Infant, Newborn; Infant, Premature, Diseases; Pancuronium; Pneumothorax

Topics: Anesthesia; Ductus Arteriosus, Patent; Fentanyl; Humans; Infant, Newborn; Infant, Premature, Diseases; Ligation; Pancuronium

Topics: Anesthesia; Enterocolitis, Pseudomembranous; Fentanyl; Humans; Infant, Newborn; Infant, Premature, Diseases; Infant, Small for Gestational Age; Pancuronium

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