pancuronium and Respiratory-Distress-Syndrome

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

To compare recovery times from neuromuscular blockade between two groups of critically ill patients in whom pancuronium was administered by continuous infusion or intermittent bolus injection. To compare the mean pancuronium requirements (milligrams per kilogram per hour) and to assess the incidence of prolonged recovery times (>12 hrs) and residual muscle weakness.. Prospective, observational cohort.. Intensive care unit in a university-affiliated hospital.. A total of 30 mechanically ventilated patients who required pharmacologic paralysis. Patients were excluded if they had renal failure (creatinine clearance <30 mL/min), heart rate >130 beats/min, hepatic failure, peripheral nerve disease or myopathy, stroke, spinal cord damage, or myasthenia gravis.. Patients were assigned to receive pancuronium either by continuous infusion (n = 14) or intermittent bolus (n = 16). Depth of paralysis was titrated to maintain one or two responses to Train-of-Four stimulation with an accelerograph and desired clinical goals. Recovery time was defined as time from discontinuation of muscle relaxant until the amplitude of the fourth twitch, measured every 15-30 min using an accelerograph, was 70% the amplitude of the first twitch (Train-of-Four > or = 0.7).. These patients included the only three patients with status asthmaticus in our study. The groups were similar with respect to age, sex, weight, Acute Physiology and Chronic Health Evaluation II score, mode of ventilation, creatinine clearance, indications for paralysis, and duration of pancuronium administration. The median time for patients to recover from paralysis was 3.5 hrs (95% confidence interval, 1.82-5.18) in the infusion group vs. 6.3 hrs (95% confidence interval, 3.40-9.19) in the intermittent bolus group (p = .10). Less drug was administered in the intermittent group (mean, 0.02+/-0.01 mg/kg/hr) than by infusion (mean, 0.04+/-0.01 mg/kg/hr; p < .001). Six patients (five in the infusion group and one in the intermittent group) developed persistent severe muscle weakness. In addition, six different patients (three from each group) had prolonged recovery >12 hrs.. Our study suggests that recovery time after paralysis with continuous infusion is faster than that after intermittent bolus injection. Although more pancuronium was administered in the continuous-infusion group, recovery time was not prolonged as a consequence. It is uncertain whether pancuronium given by infusion increases the risk of persistent muscle weakness.

Topics: Adult; Algorithms; APACHE; Critical Illness; Female; Humans; Injections; Male; Middle Aged; Muscle Relaxation; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pancuronium; Paralysis; Prospective Studies; Respiration, Artificial; Respiratory Distress Syndrome; Shock, Septic; Status Asthmaticus; Time Factors

Acute respiratory distress syndrome (ARDS) is the most severe lung injury caused by many pathologic states. We treated a patient who suffered from ARDS caused by splenic infarction. A 75-year-old patient had a gastric cancer with multiple lung and liver metastasis. During anti-cancer therapy, she developed a high fever (above 39 degrees C) and a chest and an abdominal CT scan revealed splenic infarction. Hypoxia progressed gradually and she was transferred to ICU with tracheal intubation. Mechanical ventilation was performed according to open lung strategy, but she did not recover. On ICU day 3, the bilateral infiltration shadow on her chest X-ray was pointed out, and she had a low central venous pressure. We diagnosed her ARDS. The administration of methylprednisolone was started according to Meduri's report. Hypoxia was improved gradually and on ICU day 7, she was weaned from mechanical ventilation, and extubated. On ICU day 8, she was returned to her ward without ventilatory support.

Topics: Aged; Female; Humans; Methylprednisolone; Pancuronium; Respiration, Artificial; Respiratory Distress Syndrome; Splenic Infarction

Topics: Adult; Combined Modality Therapy; Humans; Joint Diseases; Male; Neuromuscular Nondepolarizing Agents; Ossification, Heterotopic; Pancuronium; Respiration, Artificial; Respiratory Distress Syndrome

Topics: Adolescent; Drug Interactions; Drug Resistance; Female; Humans; Neuromuscular Junction; Pancuronium; Phenytoin; Respiratory Distress Syndrome

Topics: Adult; Anesthesia, Intravenous; Blood Coagulation Disorders; Blood Transfusion; Fentanyl; Fluid Therapy; Hemorrhage; Humans; Intraoperative Period; Ketamine; Kidney Diseases; Male; Pancuronium; Postoperative Complications; Respiratory Distress Syndrome; Shock

Arterial blood oxygenation improved repeatedly after sedation and paralysis in a 27-year-old woman requiring mechanical ventilation for the adult respiratory distress syndrome. Oxygen consumption and cardiac output decreased proportionately after paralysis so that the partial pressure of oxygen in mixed venous blood remained unchanged. Paralysis eliminated inspiratory distortion of the airway pressure waveform and prevented forceful use of expiratory musculature. A flow-related reduction of venous admixture or recruitment of lung volume may best explain the beneficial effect of muscle relaxation on arterial saturation.

Topics: Adult; Female; Humans; Muscle Relaxants, Central; Oxygen; Pancuronium; Pulmonary Wedge Pressure; Respiration, Artificial; Respiratory Distress Syndrome

Topics: Adolescent; Drug Resistance; Female; Humans; Hypertension; Pancuronium; Respiration; Respiration, Artificial; Respiratory Distress Syndrome; Tachycardia

Topics: Adult; Humans; Male; Pancuronium; Patient Care Planning; Respiration, Artificial; Respiratory Distress Syndrome; Spinal Cord Injuries