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Paralysis in the critically ill: intermittent bolus pancuronium compared with continuous infusion
J M de Lemos1, R R Carr, K F Shalansky
1Department of Pharmaceutical Sciences, Vancouver General Hospital, University of British Columbia, Canada.
Critical Care Medicine
|January 11, 2000
Summary
Continuous infusion of pancuronium for neuromuscular blockade in critically ill patients may lead to faster recovery times compared to intermittent bolus injections. Further research is needed to clarify the risk of persistent muscle weakness with infusion methods.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Neuromuscular Blockade
Background:
- Neuromuscular blocking agents are essential for managing mechanically ventilated patients.
- Pancuronium is commonly used for paralysis, with administration via continuous infusion or intermittent bolus injection.
- Understanding recovery profiles is crucial for optimizing patient care in intensive settings.
Purpose of the Study:
- To compare recovery times from pancuronium-induced neuromuscular blockade between continuous infusion and intermittent bolus administration.
- To evaluate differences in pancuronium requirements and the incidence of prolonged recovery or muscle weakness.
Main Methods:
- Prospective, observational cohort study in a university-affiliated hospital intensive care unit.
- 30 mechanically ventilated patients received pancuronium via continuous infusion (n=14) or intermittent bolus (n=16).
- Recovery time was defined as achieving a Train-of-Four ratio >= 0.7 after discontinuation.
Main Results:
- Median recovery time was 3.5 hours with continuous infusion versus 6.3 hours with intermittent bolus (p=0.10).
- Continuous infusion required higher mean pancuronium doses (0.04 mg/kg/hr vs. 0.02 mg/kg/hr; p<0.001).
- Prolonged recovery (>12 hrs) occurred in 6 patients; persistent muscle weakness in 6 patients (5 from infusion group).
Conclusions:
- Continuous infusion of pancuronium may result in faster recovery from neuromuscular blockade compared to intermittent bolus.
- Higher doses in the infusion group did not correlate with prolonged recovery times.
- The risk of persistent muscle weakness associated with pancuronium infusion requires further investigation.
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