pancuronium and Pneumonia--Aspiration

Laryngotracheo-esophageal cleft is a rare congenital anomaly that results from complete or partial failure of the development of the tracheoesophageal septum. The presenting symptoms include stridor, respiratory distress, and coughing or cyanotic episodes with feeding. There are four classifications for laryngeal clefts; the severity depends on the type present. We discuss the anesthesia management of a neonate with a Type IV cleft who presented for an emergency gastric division to prevent pulmonary aspiration and later returned for final repair of the defect.

Topics: Anesthesia; Anesthetics, Inhalation; Anesthetics, Intravenous; Cardiopulmonary Bypass; Esophagus; Female; Gastrostomy; Humans; Infant, Newborn; Intubation, Intratracheal; Isoflurane; Larynx; Neuromuscular Nondepolarizing Agents; Pancuronium; Piperidines; Pneumonia, Aspiration; Rare Diseases; Remifentanil; Severity of Illness Index; Tracheostomy; Treatment Outcome; Vecuronium Bromide

Topics: Drug Interactions; Eye Injuries; Gentamicins; Humans; Intubation, Intratracheal; Male; Middle Aged; Neuromuscular Blocking Agents; Pancuronium; Pneumonia, Aspiration; Time Factors; Vecuronium Bromide

The short-term effects of muscle relaxation with pancuronium bromide on arterial blood gas values, heart rate, and arterial blood pressure were studied in 49 neonates receiving mechanical ventilation. After pancuronium administration, mean PaO2 increased from 61.9 +/- 30.0 to 80.9 +/- 52.8 mm Hg (P = 0.006), mean PaCO2 decreased from 40.1 +/- 13.0 to 37.5 +/- 13.3 mm Hg (P = 0.03), and mean heart rate rose from 146.2 +/- 24.9 to 161.0 +/- 20.5 beats/min (P less than 0.001). Arterial blood pressure did not change significantly. When results were analyzed by diagnosis (meconium aspiration syndrome, hyaline membrane disease, pneumonia), only infants with meconium aspiration syndrome had a significant improvement in oxygenation (P = 0.008). Six of 18 patients with hyaline membrane disease responded to muscle relaxation, with a decrease in PaO2 of 10 mm Hg or more. No significant correlation was found between change in PaO2 and birth weight, gestational age, postnatal age, or change in heart rate. A weak correlation (r = -0.37, P less than 0.006) was observed between change in PaO2 and change in PaCO2. Although the reasons for the divergence in response in different groups of patients are not entirely clear, the risk of deterioration with pancuronium therapy should be kept in mind, particularly if treatment in an infant with hyaline membrane disease is being considered.

Topics: Blood Gas Analysis; Blood Pressure; Heart Rate; Humans; Hyaline Membrane Disease; Hypoxia; Infant, Newborn; Meconium; Pancuronium; Pneumonia; Pneumonia, Aspiration; Respiration, Artificial