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Complete respiratory paralysis caused by a large dose of streptomycin and its treatment with calcium chloride.

Several cases have been reported, in which a rather large dose of streptomycin given intraperitoneally at operation has produced respiratory paralysis. In these cases the treatment has usually consisted of respirator ventilation and administration of atropine and neostigmine. In animal experiments, in which a cessation of breathing has been produced, calcium salts have produced quick recovery. The authors present a case, in which appendicetomy was performed on a 10-year-old girl for a perforated appendix at the end of which, an overdose of intraperitoneal streptomycin was given, followed 10 minutes later by complete cessation of breathing. The patient had to be intubated again and put into a respirator. Neostigmine and atropine were used without noticeable effect. One and a half hours after the breathing had stopped 0.6 g calcium chloride was given intravenously and the girl recovered immediately and completely.

Calcium Chloride↗

[Diaphragm pacing for the ventilatory support of the quadriplegic patients with respiratory paralysis].

Electrical stimulation of the phrenic nerve to pace the diaphragm in patients with chronic ventilatory insufficiency has been an established therapeutic modality since William W.L. Glenn first described using radiofrequency signals in 1978 to stimulate the phrenic nerves. Before this event, patients who were ventilator-dependent and thus bedridden because of respiratory paralysis associated with quadriplegia usually anticipated little chance for physical or psychosocial rehabilitation. Two cases of C1-C2 subluxtion with cord injury and chronic ventilatory insufficiency were implanted at VGH-Taipei with diaphragm pacemaker in 1988. Postoperative phrenic nerve stimulation was given according to individual training schedule. One case with total phrenic paralysis received bilateral phrenic nerve stimulation and became weaned from the ventilator 6 months later. The other case with partially active ventilatory function received unilateral phrenic nerve stimulation to compensate the ventilation. However, its final outcome still showed the necessity of a bilateral mode to achieve adequate ventilation irrespective of strenuous training for 2 years.

Adult↗