pancuronium and Respiratory-Insufficiency

A case of acute myopathy was observed in the course of treatment of respiratory failure with mechanical ventilation combined with prolonged neuromuscular blockade and administration of corticosteroids. A muscle biopsy revealed degeneration of muscle fibres. Electron microscopy showed loss of thick filaments as well as nemaline rods, vacuoles and cytoplasmic bodies. The mitochondria were increased in number, many harbouring paracrystalline inclusions, which were hitherto unknown in this condition.

Topics: Combined Modality Therapy; Humans; Male; Methylprednisolone; Middle Aged; Mitochondria, Muscle; Muscular Diseases; Pancuronium; Respiration, Artificial; Respiratory Insufficiency

To determine relationships between ototoxic drugs and 4-y sensorineural hearing loss (SNHL) in near-term and term survivors of severe neonatal respiratory failure.. All 81 survivors of the Canadian arm of the Neonatal Inhaled Nitric Oxide Study (mortality 32, loss to follow-up 9) received loop diuretics, aminoglycosides, and neuromuscular blockers (NMB), and 50 received vancomycin as neonates. Prospective, longitudinal secondary outcome using audiological tests diagnosed late-onset, progressive SNHL in 43 (53%); not flat (sloping) in 29, flat (severe to profound) in 14. Risk for SNHL was determined.. A combination of duration of diuretic use of >14 d and average NMB dose of >0.96 mg/kg/d contributed to SNHL among survivors (odds ratio 5.2; 95% CI 1.6, 16.7). Markers of illness severity did not contribute. Dosage or duration of aminoglycosides use did not relate to SNHL. Cumulative dosages and duration of use of diuretics; NMB; use of vancomycin; and overlap of diuretics with NMB, aminoglycosides, and vancomycin individually linked to SNHL (p<0.001).. Overuse of loop diuretics and/or NMB contributes to SNHL after neonatal respiratory failure; markers of illness severity or the appropriate administration of aminoglycosides do not.

Topics: Amikacin; Aminoglycosides; Anti-Infective Agents; Audiometry, Pure-Tone; Auditory Threshold; Diuretics; Ethacrynic Acid; Female; Furosemide; Gentamicins; Hearing Loss, Sensorineural; Humans; Infant, Newborn; Male; Pancuronium; Respiratory Insufficiency; Severity of Illness Index; Tobramycin; Vancomycin; Vecuronium Bromide

In severe form of tetanus, even with maximum dose of muscle relaxants, spasms and apnoeic spells may persist and that may be life-threatening. The aim of this study was to assess the effect of neuroparalysing the patients and then providing ventilatory support in bringing about their recovery. Forty-nine adult patients of severe tetanus (Ablett's grade IIIA--6 patients and Ablett's grade IIIB--43 patients) were studied during the period from April, 1993 to February, 1996. Mean period of onset ie, period from trismus to first spasm, in these patients was 24 hours. Patients were neuroparalysed with a bolus dose of 2-4 mg of pancuronium followed by a continuous infusion of 1-2 mg/hour and simultaneously supported with mechanical ventilation until spasms subsided. Fourteen patients (28.6%) survived and rest died. Mean duration of ventilatory support on survived patients was 14.4 days. The commonest complication encountered during ventilatory support was respiratory tract infection observed in 36 patients (73.5%). Commonest cause of death was autonomic imbalance encountered in 15 patients (30.6%). Treatment of choice in severe tetanus should be neuroparalytic ventilatory support. With use of new generation ventilators and better intensive care facility, death in severe tetanus is likely to be very less.

Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Pancuronium; Prospective Studies; Respiration, Artificial; Respiratory Insufficiency; Respiratory Paralysis; Spasm; Tetanus

To evaluate a least squares fitting technique for the purpose of measuring total respiratory compliance (Crs) and resistance (Rrs) in patients submitted to partial ventilatory support, without the need for esophageal pressure measurement.. Prospective, randomized study.. A general ICU of a University Hospital.. 11 patients in acute respiratory failure, intubated and assisted by pressure support ventilation (PSV).. Patients were ventilated at 4 different levels of pressure support. At the end of the study, they were paralyzed for diagnostic reasons and submitted to volume controlled ventilation (CMV).. A least squares fitting (LSF) method was applied to measure Crs and Rrs at different levels of pressure support as well as in CMV. Crs and Rrs calculated by the LSF method were compared to reference values which were obtained in PSV by measurement of esophageal pressure, and in CMV by the application of the constant flow, end-inspiratory occlusion method. Inspiratory activity was measured by P0.1. In CMV, Crs and Rrs measured by the LSF method are close to quasistatic compliance (-1.5 +/- 1.5 ml/cmH2O) and to the mean value of minimum and maximum end-inspiratory resistance (+0.9 +/- 2.5 cmH2O/(l/s)). Applied during PSV, the LSF method leads to gross underestimation of Rrs (-10.4 +/- 2.3 cmH2O/(l/s)) and overestimation of Crs (+35.2 +/- 33 ml/cmH2O) whenever the set pressure support level is low and the activity of the respiratory muscles is high (P0.1 was 4.6 +/- 3.1 cmH2O). However, satisfactory estimations of Crs and Rrs by the LSF method were obtained at increased pressure support levels, resulting in a mean error of -0.4 +/- 6 ml/cmH2O and -2.8 +/- 1.5 cmH2O/(l/s), respectively. This condition was coincident with a P0.1 of 1.6 +/- 0.7 cmH2O.. The LSF method allows non-invasive evaluation of respiratory mechanics during PSV, provided that a near-relaxation condition is obtained by means of an adequately increased pressure support level. The measurement of P0.1 may be helpful for titrating the pressure support in order to obtain the condition of near-relaxation.

Topics: Acute Disease; Adult; Aged; Airway Resistance; Female; Humans; Least-Squares Analysis; Lung Compliance; Male; Middle Aged; Monitoring, Physiologic; Pancuronium; Positive-Pressure Respiration; Prospective Studies; Reproducibility of Results; Respiratory Insufficiency

Pancuronium(bromide) is used because of its relaxing effect on striated muscles and usually requires artificial respiration. A 52-year-old woman suffered from long-standing "generalized dystonia", which had become resistant to conventional therapy. Therefore, an anesthetist established a permanent medication scheme with pancuronium using a PCA pump. This pump had been controlled by the patient herself ensuring an acceptable quality of life with broad personal autonomy. Finally, the woman was found dead in her flat by a member of a home nursing service. The infusion hose showed a fixed knot and further blocking by a clamp. The autopsy findings were non-specific, except for the presence of opioid tablets in the colon. Toxicological analyses showed 72ng/ml pancuronium and 21 ng/ml oxycodone (therapeutic) in the femoral venous blood. The range of published pancuronium levels varies from approx. 80 to 2,000 ng/ml. Thus it had to be assumed that the pancuronium level was too low (72 ng/ml) so that symptoms of dystonia recurred. Based on extensive literature research, the described case can be qualified as unique. The therapy concept had been innovative, sufficient and effective for more than 10 years. It allowed the patient to enjoy a maximum of autonomy. Ultimately, death was due to the blocked pancuronium infusion. The relatively low pancuronium level had provoked the dystonia to return with generalized spasms also involving the respiratory muscles resulting in respiratory arrest. During the police investigations, two previous suicide attempts came to light.

Topics: Dystonia; Fatal Outcome; Female; Germany; Humans; Infusion Pumps; Middle Aged; Oxycodone; Pancuronium; Personal Autonomy; Recurrence; Respiratory Insufficiency; Respiratory Muscles; Self Administration; Self Medication; Spasm; Suicide

The present study was designed to determine the stability of pancuronium in postmortem blood and liver during storage. Results were obtained using the method by Kerskes et al. [C.H.M. Kerskes, K.J. Lusthof, P.G.M. Zweipfenning, J.P. Franke, The detection and identification of quaternary nitrogen muscle relaxants in biological fluids and tissues by ion-trap LC-ESI-MS, J. Anal. Toxicol. 26 (2002) 29-34.], modified and validated in our laboratory. Target analytes were isolated after enzymatic hydrolysis followed by solid phase extraction (BondElut C18 column). Internal standardisation was carried out using laudanosine and the target ions were monitored by LC-ESI-MS (monitoring ions m/z 358 for IS and 286 for pancuronium). Materials were taken from a 46-year-old woman, who had been found dead. A syringe (2 ml) and an empty ampoule of Pavulon (4 mg/2 mL) were found in her hand. The residual volume of fluid in the syringe was 0.7 ml. An autopsy was performed six days after death. It revealed a needle mark on the left thigh. Postmortem materials (muscle from the injection site, blood and liver) and the syringe with fluid were stored for four months in a freezer at -20 degrees C. The initial pancuronium concentrations were 81 ng/mL in blood and 532 ng/g in liver. The analyte was stable when stored at -20 degrees C in blood even up to seven months. In liver samples its concentrations were variable. Pancuronium in blood stored at 20 degrees C underwent degradation very rapidly. After three months of storage these blood samples had concentrations not greater about 10% of the initial value. The degradation patterns of pancuronium depended on temperature and the biological matrix.

Topics: Drug Stability; Female; Gas Chromatography-Mass Spectrometry; Humans; Injections, Intramuscular; Liver; Middle Aged; Neuromuscular Nondepolarizing Agents; Pancuronium; Reproducibility of Results; Respiratory Insufficiency; Specimen Handling; Temperature; Thigh

Topics: Catheters, Indwelling; Female; Humans; Infant; Intensive Care Units; Medical Errors; Neuromuscular Depolarizing Agents; Pancuronium; Paralysis; Respiratory Insufficiency

Paralysis with pancuronium bromide is used in newborn infants to facilitate ventilatory support during respiratory failure. Changes in lung mechanics have been attributed to paralysis. The aim of this study was to examine whether or not paralysis per se has an influence on the passive respiratory mechanics, resistance (Rrs) and compliance (Crs) of the respiratory system in newborn infants. In 30 infants with acute respiratory failure, Rrs was measured during paralysis with pancuronium bromide and after stopping pancuronium bromide (group A). Rrs was also measured in an additional 10 ventilated infants in a reversed fashion (group B): Rrs was measured first in nonparalysed infants and then they were paralysed, mainly for diagnostic procedures, and the Rrs measurement repeated. As Rrs is highly dependent on lung volume, several parameters, that depend directly on lung volume were recorded: inspiratory oxygen fraction (FI,O2), arterial oxygen tension/alveolar oxygen tension (a/A) ratio and volume above functional residual capacity (FRC). In group A, the Rrs was not different during (0.236+/-0.09 cmH2O x s x mL(-1)) and after (0.237+/-0.07 cmH2O x s x mL(-1)) paralysis. Also, in group B, Rrs did not change (0.207+/-0.046 versus 0.221+/-0.046 cm x s x mL(-1) without versus with pancuronium bromide). FI,O2, a/A ratio and volume above FRC remained constant during paralysis. These data demonstrate that paralysis does not influence the resistance of the total respiratory system in ventilated term and preterm infants when measured at comparable lung volumes.

Topics: Acute Disease; Airway Resistance; Female; Functional Residual Capacity; Humans; Infant, Newborn; Lung Compliance; Male; Neuromuscular Nondepolarizing Agents; Oxygen; Pancuronium; Respiration, Artificial; Respiratory Insufficiency

Topics: Acute Disease; Adrenal Cortex Hormones; Critical Illness; Electromyography; Humans; Neuromuscular Diseases; Pancuronium; Respiratory Insufficiency

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

Topics: Bed Rest; Female; Humans; Infant; Muscle Hypotonia; Nutritional Status; Pancuronium; Respiration, Artificial; Respiratory Insufficiency; Ventilator Weaning

Topics: Amoxicillin; Drug Contamination; Female; Humans; Hydrocortisone; Injections, Intravenous; Middle Aged; Pancuronium; Respiratory Insufficiency; Vecuronium Bromide; Vision Disorders

Topics: Adolescent; Adult; Aged; Hemodynamics; Humans; Hypnotics and Sedatives; Middle Aged; Motor Activity; Pancuronium; Pulmonary Gas Exchange; Respiratory Insufficiency

Topics: Atropine; Drug Interactions; Humans; Male; Middle Aged; Neostigmine; Nerve Block; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Pancreatic Pseudocyst; Pancuronium; Postoperative Complications; Quinine; Respiratory Insufficiency

Topics: Drug Interactions; Gentamicins; Humans; Kidney Transplantation; Male; Pancuronium; Postoperative Complications; Renal Dialysis; Respiratory Insufficiency

Topics: Age Factors; Anesthesia; Brain; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Intensive Care Units; Morphine; Neuroleptanalgesia; Oxygen; Pancuronium; Respiration, Artificial; Respiratory Insufficiency

A retrospective study of postoperative respiratory morbidity in 247 patients requiring renal transplantation between 1955 and 1973 showed that 7 patients required postoperative controlled ventilation for up to 6 days. The nondepolarising relaxants tubocurarine and pancuronium were used in only 65 patients, but all 7 cases of respiratory failure occurred in this group. This suggests that the use of these drugsin anephric patients is potentially hazardous so far as postoperative respiratory insufficiency is concerned.

Topics: Adolescent; Adult; Child; Humans; Infant; Kidney Transplantation; Middle Aged; Pancuronium; Postoperative Complications; Respiratory Insufficiency; Retrospective Studies; Succinylcholine; Transplantation, Homologous; Tubocurarine

Topics: Anesthesia; Arrhythmias, Cardiac; Body Weight; Bronchial Spasm; Female; Histamine Release; Humans; Hypotension; Infant; Infant, Newborn; Injections, Intramuscular; Male; Muscle Relaxants, Central; Neuromuscular Depolarizing Agents; Pancuronium; Postoperative Complications; Respiratory Insufficiency; Succinylcholine; Time Factors; Tubocurarine

Topics: Adjuvants, Anesthesia; Adolescent; Adult; Aged; Androstanes; Animals; Bromides; Dogs; Drug Synergism; Electromyography; Female; Humans; Male; Middle Aged; Neostigmine; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Pancuronium; Piperidines; Respiratory Insufficiency; Succinylcholine; Thiamine