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PubMed1994

Neuromuscular blockade of the fetus with pancuronium or pipecuronium for intra-uterine procedures.

Fetal movement during intra-uterine fetal therapy makes these procedures technically more difficult and increases the likelihood of trauma to the fetus. Pancuronium or pipecuronium were used in a randomised study to temporarily arrest movement in 16 fetuses undergoing intra-uterine procedures. Under ultrasound guidance, pancuronium or pipecuronium 0.2 mg.kg-1 was injected into the fetal gluteal region. Fetal movements ceased within 4.6 +/- 2.3 min in the pancuronium group and 4.5 +/- 2.8 min in the pipecuronium group and returned by 115 +/- 26 min in the pancuronium group and 121 +/- 32 min in the pipecuronium group. No adverse effects of the relaxant were observed in the mothers. There was no evidence of soft tissue, nerve or muscle damage at the fetal injection site after delivery. Both muscle relaxants provided a safer method for diagnostic and therapeutic procedures. However, four cases in the pancuronium group (50%) developed a fetal tachycardia, and two cases in the same group showed loss of beat-to-beat variability. Pipecuronium appeared to be more suitable for intra-uterine procedures.

Female↗
PubMed1981

Onset time for alcuronium and pancuronium after cremophor-containing anaesthetics.

Cremophor is a nonionic, surface-acting agent, previously shown to bind to proteins and biological membranes. The compound is used as a solvent for certain anaesthetics. The effects of this surfactant on the onset times for alcuronium and pancuronium were investigated. Both artery-to-muscle (A-M) and vein-to-muscle (V-M) onset times were determined after cremophor- and non-cremophor-containing induction agents. Circulatory effects of the surfactant were investigated by measuring the blood velocity of the brachial artery using pulsed Doppler ultrasound. A significant reduction in both A-M and V-M onset time was found for pancuronium after cremophor-containing anaesthetics. However, no difference was found for the onset times for alcuronium in the two induction groups. In contrast to alcuronium, there was no significant difference between A-M and V-M onset times for pancuronium. Arterial blood velocity was found to be practically the same after cremophor and non-cremophor induction agents. The possible of a stronger affinity of pancuronium than alcuronium to intravascular binding sites is suggested. Cremophor might, due to its protein and membrane effects, interfere with pancuronium association to these sites.

Adult↗
PubMed1996

Haemodynamic effects of high-dose vecuronium compared with pancuronium in beta-blocked patients with coronary artery disease during fentanyl-diazepam-nitrous oxide anaesthesia.

BACKGROUND: Different combinations of neuromuscular blockers and opioids have been used in patients with angina pectoris to provide cardiovascular stability and reduce risk of myocardial ischaemia during anaesthesia. METHODS: We have compared the haemodynamic effects of high-dose vecuronium (0.3 mg kg-1) with those of a standard dose of pancuronium (0.1 mg kg-1) in patients scheduled for coronary artery bypass grafting during fentanyl-diazepam-nitrous oxide anaesthesia. All patients were receiving beta-adrenergic blocking agents. The given doses of vecuronium and pancuronium are equieffective with respect to duration of neuromuscular blockade. RESULTS: During a 25-min experimental period following the administration of the randomly selected drug, no significant changes in the haemodynamic parameters were observed in the vecuronium group. The administration of pancuronium, however, resulted in a significant mean increase in heart rate (20%), rate-pressure product (23%) and cardiac index (21%). Following endotracheal intubation in the pancuronium group, we observed an additional significant increase in mean arterial pressure and rate-pressure product. CONCLUSION: High-dose administration of vecuronium has minimal haemodynamic effects and may thus offer a better alternative than pancuronium for long-lasting neuromuscular blockade in patients with coronary artery disease during fentanyl-diazepam-nitrous oxide anaesthesia.

Adrenergic beta-Antagonists↗
PubMed1993

Pancuronium does not alter the hemodynamic status of piglets after normoxia or hypoxia.

Pancuronium is a neuromuscular blocking agent commonly used to eliminate agitation in sick newborn infants requiring mechanical ventilation. Experimental data supporting this method of intervention are controversial, and hemodynamic studies in newborn infants report conflicting results. This study was designed to determine the hemodynamic effects of pancuronium administered under conditions of normoxia, hypoxia, and preexposure to hypoxia in neonatal piglets with normal lungs. After baseline hemodynamic and blood gas measurements were obtained, pancuronium was administered in two i.v. bolus injections of 0.1 mg/kg. Tidal volume and minute ventilation were maintained constant during the experimental procedure by adjusting ventilator settings. Twenty min after pancuronium, no changes from baseline values were found in arterial blood gases, heart rate, cardiac output, mean arterial pressure, systemic vascular resistance, pulmonary artery pressure, pulmonary vascular resistance, central venous pressure, or pulmonary capillary wedge pressure in any of the three conditions studied. In conclusion, pancuronium administered during normoxia, hypoxia, or after preexposure to hypoxia while controlled ventilation is maintained does not alter systemic or pulmonary hemodynamic status of the newborn piglet.

Animals↗
PubMedDate not supplied

Pyridostigmine as an antagonist of d-tubocurarine-induced and pancuronium-induced neuromuscular blockade.

In an evaluation of the clinical effectiveness of pyridostigmine as an antagonist of d-tubocurarine-induced and pancuronium-induced neuromuscular blockade in patients anesthetized with a neurolept-nitrous oxide (N2O) technic, 60 adults received either d-tubocurarine (dTc) (N equals 30) or pancuronium (N equals 30). The pancuronium-dTc potency ratio with neurolept-N2O anesthesia is 4.85:1. The mean doses of pyridostigmine necessary for 50 percent recovery of control twitch height and sustained tetanus were 5.72 plus or minus 0.45 (S.E.) mg. and 11.6 plus or minus 0.88 mg., respectively, for dTc, and 4.05 plus or minus 0.24 mg. and 8.27 plus or minus 0.41 mg., respectively, for pancuronium. There was no correlation between the amount of pyridostigmine necessary for relaxant antagonism and the total dose of relaxant used. In 24 patients, neuromuscular blockade was reversed by an intravenous injection of pyridostigmine and either 0.6 mg. or 1 mg. of atropine. Within 2 minutes, patients given 1 mg. of atropine had a significantly faster heart rate than those given 0.6 mg of atropine (p smaller than 0.0001). There was no correlation between control heart rate and maximum changes in heart rate. No cardiac arrhythmia or bronchospasm was observed in patients with either pancuronium or dTc following atropine-pyridostigmine mixtures. The cardiac muscarinic effects of pyridostigmine could be modified by simultaneous administration of 1 mg. of atropine.

Adult↗
PubMedDate not supplied

The interaction between d-tubocurarine, pancuronium, polymyxin B, and neostigmine on neuromuscular function.

The interaction between pancuronium, d-tubocurarine, polymyxin B, and neostigmine was studied in the rat diaphragm-phrenic nerve preparation. Polymyxin B (5 mug/ml) did not affect twitch tension alone but decreased the pancuronium ED50 from 0.8 mug/ml to 0.32 mug/ml and the d-tubocurarine ED50 from 0.25 mug/ml to 0.15 mug/ml. Neostigmine (0.2 to 10 mug/ml) antagonized pancuronium or d-tubocurarine-induced depression of twitch tension. In contrast, neostigmine (0.001 to 0.2 mug/ml) augmented polymyxin B depression. Similarly, neostigmine (0.1 mug/ml) augmented combined polymyxin B-pancuronium or polymyxin B-d-tubocurarine depression of twitch tension. The authors conclude that polymyxin B potentiates the neuromuscular blockade from pancuronium or d-tubocurarine and that neostigmine further augments this block.

Animals↗
PubMedDate not supplied

Influence of pancuronium of potassium efflux produced by succinycholine.

Serum potassium (K+) levels were measured after thiopental, succinylcholine, pancuronium, and pretreatment with pancuronium prior to succinylcholine, in 100 patients divided into 4 groups of 25 patients each. Significant increases in serum K+ were found after succinylcholine (1 mg/kg). Administration of pancuronium in small doses (20 mug/kg) prior to succinylcholine (1 mg/kg) was effective not only in complete prevention of serum K+ elevation but also produced consistent decrease in serum K+ concentration below control values. Both thiopental and pancuronium produced moderate fall in serum K+ levels. Our observations indicate that pretreatment with pancuronium may play a beneficial role in patients at risk from succinylcholine hyperkalemia.

Anesthesia, Intravenous↗
PubMedDate not supplied

Cardiovascular effects of meperidine-N2O anesthesia before and after pancuronium.

The cardiovascular effects of 2 and 3 mg/kg of meperidine plus 60 to 67% N2O in O2 on cardiovascular dynamics in man were measured before and after the administration of 0.08 mg/kg of IV pancuronium. N2O and 2 mg/kg of meperidine did not change heart rate (HR) but produced a marked reduction (-49%) in cardiac output (QT) plus significant decreases in stroke volume (SV) and blood pressure (BP) and an increase in peripheral arterial resistance (PVR). Additional meperidine did not further alter any of the variables; however, surgical stimulation caused significant increases in HR, BP, and PVR. SV and QT were not significantly changed by surgical stimulation and were still markedly depressed when compared to control values. Pancuronium produced marked increases in HR, SV, QT, and BP and a reduction in PVR. These changes were maximal 4 to 8 minutes after pancuronium and returned toward pre-pancuronium values thereafter. These data demonstrate that N2O-meperidine anesthesia results in a moderate reduction in BP but a marked depression in QT. The findings also indicate that pancuronium reverses the cardiovascular depression produced by N2O-meperidine and is therefore, a desirable muscle relaxant when the above technic is employed.

Anesthesia, General↗
PubMedDate not supplied

Neostigmine and 4-aminopyridine antagonism of lincomycin-pancuronium neuromuscular blockade in man.

Seven anesthetized patients were studied to determine the interaction between pancuronium and lincomycin and the ability of neostigmine and 4-aminopyridine to antagonize the block. Lincomycin 600 mg given IV alone did not decrease twitch tension. An 8 to 10% decrease in twitch tension occurred when lincomycin was given after neostigmine antagonism of pancuronium. Lincomycin augmented a partial pancuronium neuromuscular blockade. The combined lincomycin-pancuronium neuromuscular blockade was effectively antagonized by both neostigmine and 4-aminopyridine although the latter produced a slower rate of antagonism. The authros conclude that lincomycin, 600 mg IV, augments a pancuronium neurovascular blockade. 4-Aminopyridine offers no advantage over neostigmine and, in fact, may offer a disadvantage because of a slower rate of antagonism.

Adolescent↗
PubMed2003

Recovery of neuromuscular function after cardiac surgery: pancuronium versus rocuronium.

UNLABELLED: The use of pancuronium in fast-track cardiac surgical patients may be associated with delays in clinical recovery. Our objective in this study was to evaluate the incidence and severity of residual neuromuscular blockade after cardiac surgery in patients randomized to receive either pancuronium (0.08-0.1 mg/kg) or rocuronium (0.6-0.8 mg/kg). Eighty-two patients undergoing cardiopulmonary bypass were randomized to a pancuronium (n = 41) or rocuronium (n = 41) group. Intraoperative and postoperative management was standardized. In the intensive care unit, train-of-four (TOF) ratios were measured each hour until weaning off ventilatory support was initiated. Neuromuscular blockade was not reversed. After tracheal extubation, patients were examined for signs and symptoms of residual paresis. When weaning of ventilatory support was initiated, significant neuromuscular blockade was present in the pancuronium subjects (TOF ratio: median, 0.14; range, 0.00-1.11) compared with the rocuronium subjects (TOF ratio: median, 0.99; range, 0.87-1.21) (P < 0.05). Patients in the rocuronium group were more likely to be free of signs and symptoms of residual paresis than patients in the pancuronium group. Our findings suggest that the use of longer-acting muscle relaxants in cardiac surgical patients is associated not only with impaired neuromuscular recovery, but also with signs and symptoms of residual muscle weakness in the early postoperative period. IMPLICATIONS: The use of long-acting muscle relaxants in fast-track cardiac surgical patients is associated with significant residual neuromuscular block in the intensive care unit, including signs and symptoms of residual paresis.

Adult↗
PubMedDate not supplied

[Plasma histamine levels after the administration of atracurium or pancuronium in patients undergoing general anesthesia].

OBJECTIVES: To compare the release of histamine induced by atracurium and pancuronium. MATERIAL AND METHODS: We studied 20 patients ASA III undergoing vascular surgery under etomidate anesthesia. Patients were randomly treated with either 0.5 mg/kg of atracurium or 0.1 mg/kg of pancuronium as muscle relaxant agents. Plasma histamine concentration, heart rate, arterial blood pressure, PaO2, and PaCO2 were measured at the basal state and 1.2 and 5 min after administration of the muscle relaxant drug. RESULTS: Plasma histamine concentration at baseline were 0.691 +/- 0.6 ng/ml in the atracurium group and 0.756 +/- 0.612 ng/ml in the pancuronium group. These levels raised up to 2.748 +/- 6.278 ng/ml (atracurium) and 2.553 +/- 5.454 ng/ml (pancuronium). These differences were not statistically significant. The course of the remaining parameters studied in these patients was also comparable between the two groups. There were no clinical manifestations associated with the release of histamine. CONCLUSIONS: Plasma levels of histamine after administration of atracurium were not significantly different from those induced by pancuronium.

Aged↗
PubMed1992

Comparative evaluation of the neuromuscular and cardiovascular effects of pipecuronium, pancuronium, atracurium, and vecuronium under isoflurane anesthesia.

The neuromuscular and cardiovascular effects of intubating doses of pipecuronium 80 micrograms/kg, pancuronium 100 micrograms/kg, atracurium 500 micrograms/kg, and vecuronium 100 micrograms/kg were compared in 62 patients under isoflurane (end-tidal concentration = 0.5-1%) anesthesia. Pipecuronium, pancuronium, and vecuronium had no significant effect on systolic or diastolic blood pressure. In one patient the administration of atracurium resulted in significant hypotension. Heart rate was significantly increased only after the administration of pancuronium. The neuromuscular-blocking effect of pipecuronium and pancuronium appears to be twice as long as that of vecuronium and atracurium. Administration of neostigmine resulted in significantly faster recovery of muscle function in patients receiving vecuronium or atracurium. Although pipecuronium's neuromuscular-blocking effect is similar to that of pancuronium, its lack of cardiovascular effects more closely resembles that of vecuronium.

Adolescent↗
PubMed2005

Similar preoperative hemodynamic response to pancuronium and rocuronium in high-risk cardiac surgical patients.

AIM: Rocuronium may be a good alternative to pancuronium in cardiac surgical patients. We evaluate the hemodynamic response to rocuronium and pancuronium administered to cardiac surgical patients. METHODS: A single-blind, randomized clinical trial was carried out at the National Institute of Cardiology in Mexico. Twenty-two patients older than 18 years, NYHA class III-IV, and scheduled to undergo an elective cardiovascular surgical procedure were enrolled. Patients were randomly allocated to receive an i.v. bolus dose of either pancuronium 100 microg/kg or rocuronium 600 microg/kg. Peripheral arterial (radial) and venous cannulations and insertion of a multi-lumen pulmonary artery flotation catheter through the right internal jugular vein were carried out under local anesthesia. Anesthetic induction with an i.v. bolus dose of fentanyl 700 microg and diazepam 20 mg was performed and thereafter the neuromuscular blocking agent was administered. Ventilation with O2 100% was performed until a TOF < or =5% was observed and tracheal intubation was performed. After intubation, patients were maintained with O2 10 mL/kg administered by means of a pulmonary ventilator at a pressure of 20-25 cm H2O. The basal, pre-laryngoscopy, post-intubation, and pre-operative recording of a set of cardiovascular parameters were obtained. RESULTS: No differences (P>0.05) in the hemodynamic response were observed between pancuronium and rocuronium nor during the different evaluation times in each group. CONCLUSIONS: Rocuronium can be a safe alternative to pancuronium for patients requiring cardiac surgical procedures.

Adult↗
PubMed1991

Effects of pancuronium and vecuronium on plasma levels of immunoglobulins, IgG, IgM and IgE, in patients undergoing minor gynaecological surgery.

1. The effects of two competitive neuromuscular blocking agents, pancuronium and vecuronium, on plasma levels of immunoglobulins, IgG, IgM and IgE, were studied and compared, using the ELISA assay, in patients undergoing minor gynaecological surgery. 2. The results showed that neither pancuronium (0.1 mg/kg) nor vecuronium (0.1 mg/kg) had any significant effect on IgG, IgM and IgE levels in these patients. However, the underlying trend was that both pancuronium and vecuronium slightly increased the IgG and IgM levels, (by 19.5%, 22.1%, of control IgG, and by 17.3%, 28.8% of control IgM, respectively), with vecuronium being more effective than pancuronium). In addition, pancuronium, but not vecuronium, also slightly increased the IgE levels (by 5.9% of control IgE). Vecuronium, on the other hand, slightly decreased the IgE level (by 4.9% of control IgE). However, these increases or decreases were not statistically significant. 3. The significance of the present results are discussed in relation to changes in immunoglobulins and adverse effects induced by drugs, such as muscle relaxants.

Adult↗
PubMed1991

Cardio-vascular effects of vecuronium & pancuronium in patients undergoing elective closed mitral valvotomy.

Vecuronium, a monoquaternary analogue of pancuronium, the neuromuscular blocker, was compared with pancuronium in 50 patients undergoing elective closed mitral valvotomy. The patients were randomly divided into two groups of 25 each, and the muscle relaxants were administered in a dose of 0.1 mg/kg body weight. Both the agents produced identical intubating conditions at 3 min. Vecuronium showed a significantly shorter onset of action, as compared to pancuronium. The latter significantly increased the heart rate throughout the period of study whereas vecuronium significantly decreased the heart rate, 25 min after administration. There was significant increase in the mean arterial pressure (MAP) at tracheal intubation in both the groups, which persisted throughout the period of study in pancuronium group. There was a significant fall in MAP at 30 min after relaxant in vecuronium group. The incidence of arrythmias was similar and significant in both the groups. Vecuronium, thus showed a quicker onset of action with minimal haemodynamic effects, as compared to pancuronium in patients undergoing closed mitral valvotomy.

Adolescent↗
PubMed1991

Dose requirements of vecuronium, pancuronium, and atracurium during orthotopic liver transplantation.

To further elucidate the role of the liver in the clearance of vecuronium, atracurium, and pancuronium, 30 patients undergoing orthotopic liver transplantation were randomly assigned to three comparable groups to receive a continuous infusion of vecuronium, atracurium, or pancuronium. The evoked integrated compound action potential of the hypothenar eminence in response to train-of-four ulnar nerve stimulation was measured and recorded. Anesthesia was induced with 3-5 mg/kg of thiopental, 50 micrograms/kg of midazolam, and 1-5 micrograms/kg of fentanyl IV and was maintained with continuous infusions of midazolam and fentanyl while the lungs were ventilated with an air-oxygen mixture. The infusion rates of vecuronium, atracurium, and pancuronium were adjusted to achieve a T1/Tc ratio of between 0.02 and 0.10 (T1 = height of first twitch, Tc = height of control twitch). Vecuronium and pancuronium requirements, which were 0.072 +/- 0.022 and 0.042 +/- 0.015 mg.kg-1.h-1 (mean +/- standard deviation) respectively during the dissection phase, decreased significantly during the anhepatic phase to 0.036 +/- 0.021 and 0.018 +/- 0.012 mg.kg-1.h-1 and returned toward the initial values in the postreperfusion phase (0.055 +/- 0.018 and 0.032 +/- 0.012 mg.kg.-1.h-1); whereas atracurium requirements remained unchanged during the three phases (0.667 +/- 0.199, 0.567 +/- 0.142, and 0.692 +/- 0.254 mg.kg-1.h-1). These data suggest that the liver has an important role in the elimination of vecuronium and pancuronium, whereas the elimination of atracurium is unaltered during exclusion of the liver from the circulation.

Adult↗
PubMed1978

The effect of pancuronium and gallamine on muscarinic transmission in the superior cervical ganglion.

Pancuronium enhanced contraction of the nictitating membrane elicited via ganglionic muscarinic pathways in the superior cervical ganglion of the cat. In order to elucidate this phenomenon, recordings of the superior cervical ganglion surface potential were made which demonstrated that pancuronium and gallamine reduced and haloperidol enhanced ganglionic hyperpolarization without significantly altering the ganglionic slow depolarization. Pancuronium reversed the effects produced by haloperidol, whereas the latter drug was unable to antagonize those induced by pancuronium. These results allow the speculation that pharmacologically distinct muscarinic receptors reside in sympathetic ganglia, one of which is susceptible to blockade by pancuronium or gallamine.

Animals↗
PubMed1990

[Effect of cimetidine on neuromuscular blockade by succinylcholine and pancuronium].

The effect of cimetidine on neuromuscular blockade by succinylcholine and pancuronium was investigated in 54 adult patients scheduled for elective surgery. The neuromuscular blocking properties were estimated with single twitch height (T1) which was obtained by measuring the acceleration of adduction of the thumb in response to the ulnar nerve stimulation under N2O-fentanyl anesthesia. In cimetidine group, cimetidine 200 mg was administered orally on the night before surgery and 90 mins before anesthesia. Succinylcholine 1 mg.kg-1 (n = 14) or 1.5 mg.kg-1 (n = 20) was injected intravenously, and the onset time (from injection to 0% T1), the duration of maximal block (0% T1), and the recovery time from injection to 50% and 75% of control twitch height were evaluated. ED25 and ED50 of pancuronium were calculated from the dose response curve obtained by incremental administration of the drug (n = 20) whose total cumulative dose was 0.1 mg.kg-1. The recovery index of pancuronium was determined by measuring the 25%-75% recovery time. There was no significant difference between cimetidine pretreated patients and non-pretreated patients regarding these parameters of neuromuscular blockade with both succinylcholine and pancuronium. In conclusion, cimetidine has no influence on neuromuscular blockade of succinylcholine and pancuronium under N2O-fentanyl anesthesia.

Adolescent↗