Pancuronium for rapid induction technique for tracheal intubation

Abstract

A PATIEN'F with a full stomach who requires anaesthesia for an emergency operation or an obstetrical procedure is frequently managed by a rapid induction (crash) technique. This technique ordinarily includes the use of suxamethonium to provide relaxation of the jaw so that tracheal intubation can be accomplished quickly. There are a number of conditions, however, that contraindicate the use of suxamethonium. These conditions include genetic abnormalities, central nervous system lesions that result in muscle atrophy, and severe burns) Moreover, succinylcholine is not desirable when it is essential to avoid an increase in intraocular pressure or intracranial pressure, z Under these circu instances, it would be preferable to use a non-depolarizing muscle relaxant for the rapid induction technique. The purpose of this study was to determine whether there is a dose ofpancuronium that will produce adequate conditions for intubation fast enough to satisfy the purposes of a rapid intubation technique. METHODSThe study group consisted of 40 patients, 24 to 83 years of age. There were 14 males and 26 females. The total number of patients was divided into four groups often.Premedication varied according to the patient's age, physical status, degree of anxiety, presence or absence of pain and the likelihood of increased secretions or reflex activity. In some instances premedication was omitted, in others it was solely an anticholinergic drug or a tranquillizer.After appropriate premedlcation, the patients were pre-oxygenated and placed in the head-up position. Anaesthesia was induced with thiopentone 3 to 4 rag-kg -t or diazepam 20-40 rag,

Neuromuscular Blockade with Vecuronium in Paediatric Patients with Burn Injury

“…Higher than normal doses of antagonists or nondepolarizing relaxants such as pancuronium, dimethyltubocurarine (metocurine) and dtubocurarine can effect rapid onset of paralysis (Brown et al, 1979). Because of the increased acetylcholine receptors very high doses of these drugs have to be administered to achieve rapid onset of paralysis in burned patients Hagen et al, 1986).…”

Atracurium in clinical anaesthesia: effect of dosage on onset, duration and conditions for tracheal intubation

“…The use of a comparable dose (0.2 mg/kg) of pancuronium is often associated with a much prolonged block. 12 The use of halothane during anaesthesia is associated with prolongation of the block with agents such as p a n c~r o n i u m~~ and t u b o c~r a r i n e l~ and the more recently introduced v e c u r~n i u m .~~'~ The results with atracurium have been variable. While Payne and Hughes1 and Stirt el a/.'"…”

High-dose fentanyl for rapid induction of anaesthesia in patients with coronary artery disease

“…8 A different group of investigators, however, found this same dose of pancuronium when utilized with fentanyl in a balanced anaesthetic technique produced a heart rate rise of more than 20 per cent above control values in only two of ten patients and it was promptly reversed with additional fentanyl 100-150 ~g. 9 Because of the propensity of narcotics, particularly fentanyl, to produce a centrally mediated reduction in heart rate, 1~ we elected to use pancuronium, a muscle relaxant with vagolytic properties, ~t in a dosage (twice the ED9s ) shown to reliably produce rapid onset of muscular paralysis, a'9 in order to antagonize the fentanyl-induced vagotonia. Succinylcholine was avoided as it would not prevent and might even exacerbate the bradycardia that is produced when fentanyl is administered rapidly and in a large dosage to these patients with a high degree of pre-existing betareceptor blockade.…”