Failure of Pavulon to consistently provide adequate EMG attenuation for recording electrocerebral inactivity

It is important for the electroencephalographer to consult regularly and closely with the clinician ordering EEGs. This is particularly true in the relatively specialized area of recording for confirmation or support of the clinical impression of brain death. In the instances when a record is being run primarily to confirm the absence of electrocortical activity, it is clearly possible that artifact may be so high in the recording that such a determination is difficult or impossible. A particular artifact of concern is that of persisting muscle potential. As demonstrated in the cases above, this can be promptly eliminated with the use of the muscle relaxant succinylcholine chloride (Anectine). Often the use of pancuronium bromide (Pavulon) at a level that causes an equal clinical relaxation, leaves residual electrical muscle potentials that continue to make interpretation of the EEG difficult, if not actually impossible with any degree of certainty.