Respiratory flow resistance after curare and pancuronium, measured by forced oscillations

Neuromuscular transmission and its pharmacological blockade. Part 4: Use of relaxants in paediatric and elderly patients, in obstetrics, and in the intensive care unit

The pharmacodynamic and pharmacokinetic characteristics of the non-depolarizing muscle relaxants are dependent on age. Thus differences are found between paediatric patients, adults, and elderly patients. Muscle relaxants cross the placenta and thus may cause problems in the fetus. Many of the potential adverse effects of relaxant administration are seen more pronounced in intensive care patients. Prolonged effects and problems in wearing patients from the ventilator are observed when muscle relaxants are used in such patients. Critical illness neuropathy is a syndrome different from relaxant induced neuromyopathy, but may be enhanced by relaxant administration.

Pre- and postoperative inspiratory mechanics in ischemic and valvular heart disease

In 12 mechanically-ventilated, anesthetized, paralyzed patients undergoing cardiac surgery for either coronary bypass (six subjects) or to correct valvular disfunctions, volume, airflow, tracheal, esophageal, and transpulmonary pressures were measured. Respiratory system elastance and resistance were partitioned into lung and chest wall components. Resistances were further split into homogeneous and uneven elements. Measurements were performed prior to thoracotomy and just after rib cage closure. Before surgery, valvular patients had significantly higher elastances and uneven resistances of the respiratory system and lung than those with ischemic heart disease. Postoperatively, the patients presented with an increase in respiratory system and lung elastances, a decrease in pulmonary resistance, and a rise in chest wall resistance. Surgically induced mechanical changes were similar in ischemic and valvular patients.

Pancuronium and histamine release

Both d-tubocurarine and pancuronium release histamine in the skin: both have been shown to cause bronchospasm after intravenous injection. It is unlikely that skin testing with either drug will detect an individual susceptibility to bronchospasm, except as a non-specific test for atopy.