[Enflurane-pancuronium combination: real progress toward greater safe conditions in general anesthesia]

The literature data and personal experience with high - and very high - risk patients show that the association of enflurane as anaesthetic and pancuronium as muscle-relaxant constitutes a positive advance in balanced general anaesthesia. Cardiocirculatory depression is not encountered; if anything, there is an improvement of homeostatic conditions. This results in increased safety, even for patients regarded as inoperable. Confirmation of the reasons for associating these two drugs has certainly been obtained. The method cannot, however, be employed indiscriminately, but, at least in theory, should be avoided in patients with serious hypertension or a myocardium that is particularly sensitive to endogenic catecholamine incretion. In hypotension, on the other hand, cases of imminent or frank shock, or situations where surgery cannot be postponed, the association is, paradoxically, a true pharmacological "support", backed up, of course, by other usual procedures. This contradiction of modern views concerning the peripheral circulation is only apparent, since the duration of anaesthesia is reduced; main aim in this period is the maintenance of sufficient circulation to the more important organs. Comparison with associations combining d-Tubocurarine, halothane and methoxyfluorane is still an open question as far as objective assessment of their usefulness is concerned. There can be no doubt, however, that the association of enflurane and pancuronium has eliminated a large sector of contraindications in the field of general anaesthesia.