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[Prolonged curarization in the newborn infant under assisted ventilation for idiopathic respiratory distress]
Insights
Prolonged pancuronium bromide infusion in neonates with hyaline membrane disease showed excellent cardiovascular tolerance. However, muscle relaxation offered minimal benefits for respiratory support, outweighing the intensive monitoring required.
Area of Science:
- Neonatal intensive care
- Pediatric critical care
- Pharmacology
Context:
- Hyaline membrane disease (HMD) is a common respiratory distress in neonates.
- Assisted ventilation is a standard treatment for HMD.
- Neuromuscular blocking agents are sometimes used in neonatal intensive care.
Purpose:
- To evaluate the safety and efficacy of prolonged pancuronium bromide administration in neonates with HMD requiring assisted ventilation.
- To assess the impact of pancuronium on oxygen requirements, mechanical complications, and overall respiratory distress evolution.
Summary:
- Ten neonates with HMD received pancuronium bromide (0.1 mg/kg load, 0.03-0.07 mg/kg/h infusion) for prolonged periods (72-525 h).
- Cardiovascular tolerance was excellent, with no significant impact on oxygen needs, mechanical complications, or respiratory distress.
- The benefits of pancuronium were deemed minimal compared to the intensive monitoring required for corneal, cutaneous, vesical, and tracheal care.
Impact:
- Prolonged pancuronium administration in neonates with HMD offers limited clinical benefits.
- The intensive monitoring required for pancuronium therapy may outweigh its advantages in this population.
- This study suggests a cautious approach to using neuromuscular blockers for extended periods in neonatal respiratory care.
Abstract:
We studied the effects of prolonged pancuronium administration in 10 neonates under assisted ventilation for hyaline membrane disease. Pancuronium bromide was administered from the time of intubation with a load dose of 0.1 mg/kg followed by a continuous infusion of 0.03-0.07 mg/kg/h. Tolerance, especially cardiovascular, was excellent after 72 to 525 h of therapy (mean 173 h). Oxygen needs, incidence of mechanical complications and the general evolution of idiopathic respiratory distress were not significantly affected by muscle relaxation. The benefits of systematic pancuronium administration during respiratory intensive care in neonates with hyaline membrane disease appear to be of little value when considering the necessary constraints (corneal, cutaneous, vesical and tracheal supervision).