Assuntos
Relaxantes Musculares Centrais/efeitos adversos , Fármacos Neuromusculares Despolarizantes/efeitos adversos , Doenças Neuromusculares/complicações , Procedimentos Cirúrgicos Operatórios , Esclerose Lateral Amiotrófica/complicações , Curare , Hemiplegia/complicações , Humanos , Hiperpotassemia/induzido quimicamente , Hipertermia Maligna/etiologia , Esclerose Múltipla/complicações , Distrofias Musculares/complicações , Miastenia Gravis/complicações , Miotonia/complicações , Paralisia/induzido quimicamente , Paralisia/complicações , Doença de Parkinson/complicações , Doenças do Sistema Nervoso Periférico/complicações , Poliomielite/complicações , Risco , Succinilcolina/efeitos adversos , Transmissão Sináptica/efeitos dos fármacos , Tétano/complicaçõesRESUMO
A 17 year old male with a history of bronchial asthma was admitted to the intensive care unit in severe respiratory distress. During a two week period of intensive respiratory care he received large doses of aminophylline and corticosteroids. In addition, pancuronium was given to facilitate ventilation and to reduce airway pressure. Large doses of pancuronium, as much as 5 mg/hr, were required to stop spontaneous respiratory efforts and restlessness. The total pancuronium dose given during the two week period was 800 mg. One hour after pancuronium was discontinued the patient could open his eyes and move his lips. Peripheral nerve stimulation indicated partial paralysis which improved promptly following a test dose of edrophonium. The authors speculate the aminophylline, which is a known inhibitor of the enzyme phosphodiesterase, raised the level of c-AMP and, in turn, the level of acetylcholine at the neuromuscular junction and thus antagonized the blocking effect of pancuronium. In addition, the large doses of corticosteroids that the patient had received may have enhanced the release of acetylcholine and further facilitated neuromuscular transmission.
Assuntos
Corticosteroides/efeitos adversos , Aminofilina/efeitos adversos , Anestesia , Asma/tratamento farmacológico , Pancurônio/antagonistas & inibidores , Adolescente , Corticosteroides/uso terapêutico , Aminofilina/uso terapêutico , Interações Medicamentosas , Resistência a Medicamentos , Humanos , MasculinoRESUMO
Two groups consisting of 10 A.S.A. class I-II neurosurgical patients each were studied to determine whether patients require greater quantities of pancuronium to maintain paralysis after having been given furosemide, 1 mg/kg. After a standardized barbiturate, narcotic and nitrous oxide induction of anesthesia, pancuronium was given intravenously until twitch response was suppressed by 95%. The study group received in addition furosemide, 1 mg/kg, 10 minutes prior to induction of anesthesia. Mean recovery time from 95% to 50% twitch suppression was 21.8 minutes in the control group and 14.7 minutes in the study group. Urinary output was significantly greater (13.5 vs 674 ml) and serum potassium levels lower (4.05 vs 3.85 meq/L) in the study group during recovery of twitch response. Furosemide, 1 mg/kg, facilitates recovery of evoked twitch response after pancuronium.