Curare in the treatment of pulmonary hypertension as it occurs in the idiopathic respiratory distress syndrome

Abstract

Thirteen infants with pulmonary hypertension occurring in the course of the idiopathic respiratory distress syndrome received curare on 26 occasions. The histaminic effect of curare in relieving the shunting was minimal, whilst its muscle relaxant properties might be important in determining the outcome. The survival rate was 54%all those dying having intraventricular haemorrhage. The alveolar-arterial oxygen tension gradient proved the most sensitive index of shunting whilst the arterial/alveolar oxygen tension ratio and the arterial oxygen tensionlfraction of inspired oxygen ratio might prove more useful clinically. Key WordsCurare, pulmonary hypertension and hypoperfusion, idiopathic respiratory distress syndrome, intraventricular haemorrhage, indices of shunting, severe hypoxaemia.

Refractory Persistent Pulmonary Hypertension of the Newborn Responsive Only to Neuromuscular Blockade

“…Henry et al [3] described similar findings and suggested that curare induces respiratory paralysis, which would reduce right to left shunting, hence improving PaO2 and finally decreasing mortality in infant with severe PPHN. One year later Hutchison and Yu [4] examined the effect of curare in the treatment of PPHN. Curare decreased PVR in only one infant out of thirteen.…”

“…In the pre inhaled nitric oxide (iNO) era (before 1993) a wide variation in treatment of this entity was noted and one of the possibilities was neuromuscular blockers [3,4]. We present a patient with PPHN refractory to iNO for whom, neuromuscular blockers were beneficial.…”