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Cardiovascular and Neuromuscular Responses to High-dose Pancuronium-Metocurine in Pediatric Burned and Reconstructive Patients

Received from the Department of Anesthesiology, Harvard Medical School and the Anesthesia Services of Massachusetts General Hospital and Shriners Burns Institute, Boston, Massachusetts.

Abstract

The efficacy of the combined use of pancuronium and metocurine (Pm-MTC) in high doses to produce rapid-onset muscle paralysis was evaluated in 15 patients with acute burns and 18 recovered burned patients scheduled for reconstructive surgery. Two and three times the previously determined ED₉₅ of the combination for each group was used. (ED₉₅for Pm-MTC combination is 0.032/0.129 mg/kg for acute burns and 0.013/0.051 mg/kg for reconstructive patients.) Doubling ED₉₅ produced 95% paralysis in 3.1 ± 0.9 min in acutely burned children and in 4.3 ± 0.7 min in reconstructive children (mean ± SEM). These onset times were not significantly different from each other. Tripling the ED₉₅ of the combination in burned children reduced the onset time to 1.3 ± 0.14 min, but this was not significantly different from 2 x ED₉₅ onset time in burned patients. The administration of 3 x ED₉₅ to the reconstructive group, however, resulted in a significantly more rapid onset time of 1.8 ± 0.4 min compared with 2 x ED₉₅ in the same population. With 3 x ED₉₅ the onset times between burn and reconstructive patients were not significantly different. Time for recovery of twitch to 25% of control twitch height (75% twitch depression) was significantly prolonged in burned patients compared with reconstructive patients for equipotent doses administered. Although the occasional patient showed prominent changes in heart rate and blood pressure, overall cardiovascular stability was impressive. Therefore, high doses of Pm-MTC combination can be used in combination to produce more rapid onset of paralysis in burned patients and may also represent an alternative to succinylcholme in other situations wherein there is risk of succinylcholine-induced hyperkalemia. This technique does not provide as rapid onset of paralysis as succinylcholine.

Key Words: ANESTHESIA—pediatric. • COMPLICATIONS—burns. • NEUROMUSCULAR RELAXANTS—pancuronium, metocurine.

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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