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Breathing Patterns during Curare-Induced Muscle Weakness

Departments of Anesthesiology, Medicine, and Surgery, College of Physicians and Surgeons, Columbia-Presbyterian Medical Center, New York, New York.

Abstract

This study examines the pattern of breathing used by normal subjects to compensate for an acute decrease in muscle strength. A continuous infusion of curare was used to reduce peak inspiratory pressure in six normal subjects from normal control levels to –45 cm H₂O (moderate weakness) and to –70 cm H₂O (mild weakness). Before administration of curare, inspiratory pressure exceeded –120 cm H₂O. A canopy-computer-spirometer system was used for noninvasive spirometry and measurements of gas exchange. Partial curarization to a mild level of muscle weakness did not produce significant changes in the respiratory functions studied. With a moderate level of muscle weakness, there were significant increases in tidal volume from 166 to 186 ml/m² and in inspiratory time from 1.51 to 1.71 sec (P < 0.05). Minute ventilation and inspiratory flow did not change. However, when given 3% CO₂, both normal and partially curarized subjects increased minute ventilation, from 2.3 to 5.7 L/min/m² and from 2.5 to 6.7 L/min/m², respectively. The increases in both conditions were secondary to increases in tidal volume. There was also a small increase in respiratory frequency from 15.4 to 18 breaths/min, P < 0.01 in the partially curarized group given 3% CO₂. Because minute ventilation was preserved while vital capacity decreased, it is proposed that respiration is maintained in the presence of muscle weakness associated with curare by diaphragmatic function which remains relatively unaffected by curarization.

Key Words: VENTILATION: d-tubocurarine • NEUROMUSCULAR RELAXANTS: d-tubocurarine

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999