Recovery from pancuronium blockade in the neonatal intensive care unit

Neuromuscular blockade with pancuronium and its antagonism was evaluated in 33 critically ill infants. The evoked contraction of the adductor pollicis from indirect stimulation of the ulnar nerve was measured. The neuromuscular blockade recovered spontaneously from pancuronium in seven infants, 23 required one or more doses of atropine 0.02 ng kg-1 and neostigmine 0.06 mgkg-1. In three infants the blockade failed to reverse. Immature infants less than 32 weeks did not show any significant different in their requirement for pancuronium compared with mature infants. Age and birth weight of the infant, dose of pancuronium and duration of its administration did not affect the requirements for reversal. Train-of-four and tetanus; twitch ratios were lower (P less than 0.05) in infants less than 32 weeks of developmental age reflecting immaturity of neuromuscular transmission.