pancuronium and Poisoning

The physiology and pathology of different methods of capital punishment are described. Information about this physiology and pathology can be derived from observations on the condemned persons, postmortem examinations, physiological studies on animals undergoing similar procedures, and the literature on emergency medicine. It is difficult to know how much pain the person being executed feels or for how long, because many of the signs of pain are obscured by the procedure or by physical restraints, but one can identify those steps which are likely to be painful. The general view has been that most of the methods used are virtually painless, and lead to rapid dignified death. Evidence is presented which shows that, with the possible exception of intravenous injection, this view is almost certainly wrong.

Topics: Capital Punishment; Cause of Death; Female; Humans; Injections, Intravenous; Male; Pain; Pain Measurement; Pancuronium; Poisoning; Thiopental; Wounds and Injuries

Pancuronium bromide is a nondepolarizing muscle relaxant approved to induce skeletal muscle relaxation during anesthesia and to facilitate the management of patients undergoing mechanical ventilation. The use of pancuronium bromide during surgery led to the appreciation that it has advantages over drugs previously used for muscle relaxation. Patients in whom pancuronium bromide is of value are (1) hypoxemic patients resisting mechanical ventilation and so cardiovascularly unstable that use of sedatives is precluded, (2) patients with bronchospasm unresponsive to conventional therapy, (3) patients with severe tetanus or poisoning where muscle spasm prohibits adequate ventilation, (4) patients with status epilepticus unable to maintain their own ventilation, (5) shivering patients in whom metabolic demands for oxygen should be reduced, and (6) patients requiring tracheal intubation in whom succinylcholine administration is contraindicated. Without concomitant sedation, use of pancuronium bromide is associated with psychological risks. Other risks are undetected ventilator disconnection, tachyarrythmias, prolonged paralysis and drug interactions.

Topics: Animals; Asthma; Drug Interactions; Humans; Hypothermia; Intubation, Intratracheal; Pancuronium; Poisoning; Respiratory Distress Syndrome; Status Epilepticus; Tetanus

A 46-year-old man presented two hours after ingestion of about 250 mg strychnine with severe violent, generalized convulsions, triggered by external stimuli. During the convulsion-free periods there were no abnormal signs in the physical examination.. The presence of strychnine was confirmed by urine analysis with gas chromatography-mass spectrometry.. Because diazepam as anticonvulsant of choice was not effective in abating the convulsions the patient was intubated. A combination with midazolam, fentanyl and pancuronium was effective in controlling the convulsions. The patient was discharged from ICU on day three.. Fatal outcome of strychnine poisoning demands an aggressive management with early intubation, control of muscle tremors and prevention of rhabdomyolisis and renal failure.

Topics: Analgesics, Opioid; Anti-Anxiety Agents; Chromatography, Gas; Drug Therapy, Combination; Fentanyl; Humans; Male; Midazolam; Middle Aged; Neuromuscular Nondepolarizing Agents; Pancuronium; Poisoning; Strychnine; Suicide, Attempted; Treatment Outcome

A case is reported of voluntary acute carbofuran poisoning. The clinical presentation was suggestive and i.v. atropine sulphate was immediately administered. In the absence of a specific antidote, curarization with pancuronium bromide with assisted ventilation and diazepam sedation was used to treat the persistent nicotinic myoclonic state. No rhabdomyolysis was observed.

Topics: Adult; Atropine; Carbamates; Cholinesterase Inhibitors; Emergencies; Humans; Male; Pancuronium; Poisoning; Respiration, Artificial

Topics: Humans; Intubation; Pancuronium; Poisoning; Unconsciousness

Topics: Heart Arrest; Homicide; Hospitals, Veterans; Humans; Medication Errors; Michigan; Pancuronium; Poisoning

Topics: Adult; Diazepam; Female; Gastric Lavage; Humans; Male; Pancuronium; Poisoning; Respiration, Artificial; Rodenticides; Seizures; Strychnine; Suicide, Attempted