Abstract
Although selective paralysis significantly reduces the incidence of pneumothoraces, initiation of paralysis with pancuronium has been associated with transient hypoxia and catecholamine surge, both of which could hazardously affect cerebral blood flow. This study investigated the effectiveness of increasing ventilator settings 1 immediately prior to paralysis to try and prevent transient hypoxia and consequent rise in catecholamine levels resulting from hypo- ventilation (associated with the first dose of pancuronium). 18 infants GA 30 wks (range 26-34), <48 hrs old and ventilated for RDS were entered into the study. Peak inspiratory pressure (PIP) was increased from mean 23 cms H2O (range 14-40) to 27 cms H2O (range 20-43) immediately before paralysis. Comparison of arterial blood gases immediately before and 20 mins after paralysis did not detect a change in PH or PCO2. In all infants arterial oxygenation rose post-paralysis but not significantly. Adrenaline was detected in 8 infants only with no consistent changes following pancuronium. The mean pre-paralysis noradrenaline level was 21.5nmol/l (range 3.3-78.9). Levels were significantly reduced post-paralysis 10.2nmol/l (range 1.7-29.9)p<0.05. These results suggest increasing PIP immediately prior to paralysis can effectively prevent the initial and transient disturbance of oxygenation and catecholamine surge previously associated with this otherwise beneficial treatment.
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Greenough, A., Pool, J. & Lagercrantz, H. PREVENTION OF HYPOXIA AND CETECHOLAMINE SURGE ASSOCIATED WITH INITIATION OF PARALYSIS BY PANCURONIUM IN PRETERM VENTILATED INFANTS. Pediatr Res 22, 228 (1987). https://doi.org/10.1203/00006450-198708000-00088
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DOI: https://doi.org/10.1203/00006450-198708000-00088