Pharmacology and use of muscle relaxants in infants and children

Nugent, Stephen K.; Larvuso, Raymond; Rogers, Mark C.

doi:10.1016/s0022-3476(79)80608-3

Cited by 34 publications

(6 citation statements)

References 28 publications

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“…Plasma cholinesterase deficiency should be suspected if paralysis following a single dose exceeds 3-5 min [9]. Patients with atypical forms of enzyme as the cause of decreased ChE activity are unusually sensitive toward succinylcholine, while adults with normal enzyme require very low levels of ChE (less than 1 U/ml) to cause moderately prolonged apnea and delay in twitch recovery times.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to nondepolarizing muscle relaxants (i.e. pancuronium, rf-tubocurarine), succinylcholine-induced paralysis is not generally revers ible with anticholinesterase agents [9], No studies have been done in pre term infants to determine the relationship of enzyme activity or enzyme variants and neuromuscular blockade by depolarizing paralytic agents.…”

Section: Discussionmentioning

confidence: 99%

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Transient Plasma Cholinesterase Deficiency in Preterm Infants

Strauss¹,

Modanlou²

1986

Dev Pharmacol Ther

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Plasma cholinesterase (ChE) activity was determined shortly after birth in 39 healthy preterm and 20 term infants using a commercially available screening assay. 40 samples of adult blood were analyzed for comparison purposes. There were no statistically significant differences in abnormally low enzyme levels in preterm or term infants and adults. Furthermore, in the preterm infants, ChE activity could not be correlated to gestational age, sex or race. Initially low ChE levels rose to normal adult levels within 2 weeks in all but 2 preterm infants. When muscle relaxant use is deemed necessary in hospitalized preterm infants, measurement of enzyme activity or use of drugs other than succinylcholine may be indicated on the basis of transient ChE deficiency.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transient Plasma Cholinesterase Deficiency in Preterm Infants

Strauss¹,

Modanlou²

1986

Dev Pharmacol Ther

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“…Pancuronium is a competitive non-depo larizing neuromuscular blocker [25], The competition takes place at the post-junc tional membrane acetylcholine receptor sites. Immediate effects are mild tachycardia with a slight increase in MABP and CO [23,24], However, according to our study design these effects are unlikely at the time of CBF and CO determinations performed 30 min after drug injection.…”

Section: Discussionmentioning

confidence: 99%

“…Pancuronium does not, as other myorelax ant drugs, induce histamine release that could act on the vessels and sympathie gan glionic release [25,26,28]. It has been shown to induce adrenergic transmitter release from post-ganglionic nerve ending, which can explain the initial rise in MABP and tachycardia observed immediately after in jection [26] but not the long-lasting observed effects on CBF and CBF AR.…”

Section: Discussionmentioning

confidence: 99%

Autoregulation of Cerebral Blood Flow

Monin¹,

Hascoët²,

Vert³

1989

Dev Pharmacol Ther

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The effect of phenobarbital and pancuronium on cerebral blood flow (CBF) and CBF autoregulation are studied in newborn piglets after chemically induced seizures with bicuculline. Given 3 or 15 min after the onset of seizures, phenobarbital significantly reduces CBF (59 ±11 and 56 ± 17 vs. 84 ± 24 ml/min/100 g - p < 0.01). Moreover, during graded hypotension induced by graded haemorrhage, phenobarbital provides reestablishment of CBF autoregulation altered by seizures. In the same experimental model, pancuronium induces in control animals a rise of CBF (61 ± 15 vs. 38 ± 11 ml/min/100 g - p < 0.001). During graded hypotension pancuronium is associated to a loss of CBF autoregulation (r = 0.76, p < 0.001). Given as an adjunct treatment, in case of seizures, pancuronium has no significant effect on changes in cerebral haemodynamics. From these data, we conclude that pancuronium jeopardizes the haemodynamic adaptation to the induced hypovolemia and that phenobarbital may present a protective effect on cerebral haemodynamics and the subsequent risk for ischaemia or haemorrhage.

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“…¿/-Tubocurarine and pancuronium are competitive neuromuscular blocking agents frequently used in neonates with respiratory distress syndrome to reduce total body oxy gen consumption, improve ventilation and reduce pulmonary barotrauma [1,2], A re cent report indicates that pancuronium ad ministration could be associated with fluid retention without overt renal failure in pre term neonates [3]. Several pharmacological properties of ¿/-tubocurarine and pancuron ium suggest the possible occurrence of renal side effects: ( 1 ) ¿/-tubocurarine induces hista mine release and sympathetic ganglionic blockade causing peripheral vasodilatation and systemic hypotension; (2) pancuronium administration increases catecholamine plasma concentrations and blood pressure in newborn infants thus suggesting a sympa thetic nervous stimulation [4][5][6].…”

mentioning

confidence: 99%

Renal Effects of <i>d</i>-Tubocurarine and Pancuronium in the Newborn Rabbit

Gouyon¹,

Torrado²,

Jp³

1988

Neonatology

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The acute renal effects of d-tubocurarine and pancuronium were assessed in 14 anesthetized newborn rabbits. Glomerular filtration rate (GFR) and renal blood flow (RBF) were calculated from the inulin and p-aminohippuric acid clearances, respectively. Each animal acted as its own control. At doses used in human neonates, d-tubocurarine administration (0.80 mg/kg) produced a marked increase in renal vascular resistance (+123 ± 62%) with a concomitant significant decrease in GFR (––35.4 ± 12%) and RBF (––39 ± 13%). Pancuronium administration (0.25 mg/kg) was associated with a nonsignificant decrease in GFR (––19 ± 17%) and RBF (––20 ± 12%) and an increase in renal vascular resistance (+66 ± 52%). These results stress the need for careful monitoring of renal function in neonates receiving nondepolarizing muscle-relaxant agents.

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Pharmacology and use of muscle relaxants in infants and children

Cited by 34 publications

References 28 publications

Transient Plasma Cholinesterase Deficiency in Preterm Infants

Transient Plasma Cholinesterase Deficiency in Preterm Infants

Autoregulation of Cerebral Blood Flow

Renal Effects of <i>d</i>-Tubocurarine and Pancuronium in the Newborn Rabbit

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