pancuronium and Rhabdomyolysis

Stress-susceptible (SS) pigs develop rhabdomyolysis and increased serum levels of muscle enzymes after a 12 min experimental stress induced by the depolarizing myorelaxant succinylcholine. It is suspected that not only the stress situation but also succinylcholine itself contributes to the skeletal muscle lesions. This experiment was performed to study whether rhabdomyolysis occurs after restraint stress when succinylcholine was replaced by the non-depolarizing myorelaxant pancuronium. Four normal and four SS pigs were subjected to restraint stress by intravenous injection of pancuronium. The neuromuscular block was reversed after 12 min by neostigmine. The animals wee necropsied approximately 48 h after stress and 24 skeletal muscle groups were examined pathologically. The severity of acute myofibre lesions were graded, and the results were compared with the results from normal and SS pigs which had been subjected to restraint stress induced by succinylcholine. The serum levels of creatine kinase (CK) and aspartate aminotransferase (ASAT) stayed at the base line level after the stress. The scores for muscle lesions were significantly lower, both in normal and SS pigs, than after restraint stress induced by succinylcholine indicating no rhabdomyolysis after restraint stress induced by pancuronium. Thus succinylcholine is synergistic with stress, exacerbating its effect on skeletal muscle in SS pigs.

Topics: Animals; Female; Immobilization; Male; Muscle, Skeletal; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pancuronium; Rhabdomyolysis; Stress, Physiological; Succinylcholine; Swine; Swine Diseases

Neuroleptic malignant syndrome is an idiosyncratic reaction associated with the use of neuroleptic drugs. We report a case of this rare syndrome in a head injury patient associated with some unusual features: rhabdomyolysis with a high level of creatine kinase, the development of acute renal failure, the early use of continuous venovenous haemofiltration in treatment and rigidity that was refractory to conventional treatment with dantrolene and bromocriptine. The diagnosis in patients with multiple injuries must be based on a high index of suspicion.

Topics: Adolescent; Bromocriptine; Craniocerebral Trauma; Creatine Kinase; Dantrolene; Hemofiltration; Humans; Male; Multiple Trauma; Neuroleptic Malignant Syndrome; Pancuronium; Rhabdomyolysis

A case is reported of a 74-year-old man who developed rhabdomyolysis during treatment for status asthmaticus. This patient had a history of asthma. He was admitted after a cardiac arrest during a severe asthma attack. Continuous muscle relaxation (4 mg.h-1 of pancuronium for 10 days; total dose 960 mg) was required to carry out mechanical ventilation. Bronchodilators and high doses of steroids (300 mg.day-1 of methylprednisolone for 10 days) were also given. After the administration of muscle relaxant had been discontinued, the patient displayed a severe, predominantly proximal, quadriplegia as well as a raised blood creatinine kinase concentration. The urine was brown coloured over a 24 h period. Rhabdomyolysis was confirmed by muscle biopsy. The patient recovered over a period of one month. This case is discussed in the light of some other similar reports in the literature. It seems that the combination of muscle relaxant with high doses of steroids is to be incriminated.

Topics: Acute Disease; Aged; Creatine Kinase; Critical Care; Drug Therapy, Combination; Humans; Male; Methylprednisolone; Pancuronium; Rhabdomyolysis; Status Asthmaticus

Topics: Acute Disease; Adult; Drug Therapy, Combination; Female; Humans; Hydrocortisone; Methylprednisolone; Pancuronium; Rhabdomyolysis; Status Asthmaticus; Vecuronium Bromide