pancuronium and Pneumonia

To investigate the effect of single dose and continuous skeletal muscle paralysis on respiratory system compliance in 53 paediatric intensive care patients.. Prospective clinical study.. Multidisciplinary paediatric intensive care unit.. Twenty-three children ventilated for acute pulmonary pathology, and 30 ventilated for isolated intracranial pathology, who initially had normal lungs.. The 23 patients with acute pulmonary pathology received a single dose of muscle relaxant to facilitate diagnostic procedures. Fifteen patients with isolated intracranial pathology received continuous skeletal muscle paralysis for longer than 24 h, and the other 15 received no paralysis.. Respiratory system compliance deteriorated by 14% from 0.519 +/- 0.2 to 0.445 +/- 0.18 ml cmH2O-1 kg-1 (p < 0.001) following a single dose of muscle relaxant in the 23 patients with acute pulmonary pathology. In the 15 with isolated intracranial pathology who received continuous skeletal muscle paralysis there was a progressive deterioration in compliance, which reached 50% of the initial compliance by day 4 of paralysis (p < 0.001) and improved back to normal following discontinuation of paralysis. There were no changes in compliance in the 15 patients with isolated intracranial pathology who were ventilated but not paralysed. The paralysed patients required mechanical ventilation longer than the non-paralysed patients (p < 0.001), and 26% of these patients developed nosocomial pneumonia (p = 0.03), a complication that was not seen in the non-paralysed patients.. Skeletal muscle paralysis results in immediate and progressive deterioration of respiratory system compliance and increased incidence of nosocomial pneumonia. The benefits of paralysis should be balanced against the risks of deteriorating pulmonary function.

Topics: Acute Disease; Adolescent; Brain Diseases; Child; Child, Preschool; Craniocerebral Trauma; Cross Infection; Humans; Infant; Lung Compliance; Lung Diseases; Neuromuscular Nondepolarizing Agents; Pancuronium; Pneumonia; Prospective Studies; Respiration, Artificial; Time Factors

Many patients mechanically ventilated for acute respiratory failure, are treated with medication that includes a combination of cortico-steroids and non-depolarizing neuromuscular-blocking agents (NNBa). A third of them can be expected to develop delayed neuromuscular damage, which may be severe and prolonged. We describe a 50-year-old man who suffered from acute myeloid leukemia and was ventilated due to pneumonia. He was treated with pancuronium and cortico-steroids, and during recovery suffered quadriparesis that lasted several months. Typically this damage is purely motor and is accompanied by absent tendon-reflexes, sometimes with elevated creatine-kinase. Muscle biopsy usually shows deletion and degeneration of thick myosin filaments. The phenomenon is related to the duration of NNBa treatment, and probably results from an adverse synergistic effect on muscle tissue of the cortico-steroids and cortico-steroid-like NNBa given the immobilized patient. Awareness of this adverse effect of steroids and pancuronium, the use of passive mobilization, shortening the use of NNBa and early rehabilitation would minimize disability due to this phenomenon.

Topics: Adrenal Cortex Hormones; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Pancuronium; Paralysis; Pneumonia; Reflex; Respiration, Artificial; Tendons

The aim of this study was to identify risk factors associated with postoperative pulmonary complications. The influence of the anaesthetic technique was evaluated (i.e. general contra regional anaesthesia and long contra intermediately acting muscle relaxants (pancuronium and atracurium)) taking into account the patient's age, the presence or absence of chronic obstructive lung disease (preoperative risk factors), the type of surgery and the duration of anaesthesia (perioperative risk factors). Seven thousand and twenty-nine patients undergoing abdominal, urological, gynaecological or orthopaedic surgery were included in the study. A total of 290 patients (4.1%) suffered from one or more postoperative pulmonary complications. Six thousand and sixty-two patients received general anaesthesia and 4.5% of these had postoperative pulmonary complications. Of the patients admitted to major surgery receiving pancuronium, 12.7% (135/1062) developed postoperative pulmonary complications, compared to only 5.1% (23/449) receiving atracurium (P < 0.05). When stratified for type of surgery and duration of anaesthesia, conventional statistics showed no difference between pancuronium and atracurium as regard postoperative pulmonary complications. However, a logistic regression analysis indicated that long-lasting procedures involving pancuronium entailed a higher risk of postoperative pulmonary complications than did other procedures. In patients having regional anaesthesia, only 1.9% (18/967) developed postoperative pulmonary complications (P < 0.05 compared to general anaesthesia). However, when stratified for type of surgery there was a significantly higher incidence of postoperative pulmonary complications only in patients undergoing major orthopaedic surgery under general anaesthesia, 11.5% compared to 3.6% in patients given a regional anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Age Factors; Aged; Anesthesia Recovery Period; Anesthesia, Conduction; Anesthesia, General; Atracurium; Bupivacaine; Denmark; Humans; Incidence; Lung Diseases; Lung Diseases, Obstructive; Middle Aged; Pancuronium; Pneumonia; Postoperative Complications; Prospective Studies; Pulmonary Atelectasis; Respiratory Insufficiency; Risk Factors; Surgical Procedures, Operative; Time Factors

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