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Diaphragmatic function in healthy subjects during partial curarization

T J Gal, S K Goldberg

    Journal of Applied Physiology: Respiratory, Environmental and Exercise Physiology
    |June 1, 1980
    PubMed
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    d-tubocurarine (dTc) causes diaphragmatic weakness, reducing maximum static transdiaphragmatic pressure (Pdimax). However, quiet breathing is unaffected, while maximum voluntary ventilation (MVV) decline is linked to upper airway obstruction.

    Area of Science:

    • Respiratory Physiology
    • Neuromuscular Pharmacology

    Background:

    • Diaphragmatic function is crucial for ventilation.
    • Neuromuscular blocking agents like d-tubocurarine (dTc) can impair respiratory muscle strength.

    Purpose of the Study:

    • To assess the impact of progressive partial paralysis induced by dTc on diaphragmatic function.
    • To evaluate the effects of dTc on different measures of respiratory performance.

    Main Methods:

    • Eight healthy subjects received increasing doses of dTc.
    • Transdiaphragmatic pressure (Pdi) was measured during quiet breathing, maximal inspiration, and maximum voluntary ventilation (MVV).
    • Maximum static transdiaphragmatic pressure (Pdimax) was assessed at various lung volumes.

    Main Results:

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    • A cumulative dose of 0.2 mg/kg dTc significantly reduced Pdimax to 42% of baseline.
    • Diaphragmatic weakness had minimal impact on quiet breathing but moderately affected maximal inspiration.
    • MVV decreased significantly, preceding a drop in dynamic Pdi, suggesting upper airway obstruction.

    Conclusions:

    • Progressive neuromuscular blockade with dTc causes significant diaphragmatic weakness.
    • Reduced MVV in dTc-paralyzed subjects is primarily due to upper airway obstruction and pharyngeal muscle weakness.
    • Compensatory mechanisms may maintain quiet breathing despite diaphragmatic weakness.