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Pancuronium attenuates associated hemodynamic and transcutaneous oxygen tension changes during nursery procedures
H S Bada1, T M Burnette, K L Arheart
1Department of Pediatrics, University of Tennessee, Memphis.
Insights
Pancuronium bromide stabilized blood pressure and oxygenation in premature infants during medical procedures. This may help prevent intraventricular hemorrhage in preterm babies.
Area of Science:
- Neonatal physiology
- Pharmacology
Background:
- Intraventricular hemorrhage (IVH) in premature infants is linked to blood pressure (BP) fluctuations from motor activity.
- Pancuronium administration can stabilize cerebral blood flow velocity (CBFV) and BP patterns.
Purpose of the Study:
- To assess if pancuronium attenuates BP, transcutaneous oxygen tension (TcPO2), and CBFV variability during nursery procedures in ill premature infants.
Main Methods:
- Fourteen premature infants received a single intravenous dose of pancuronium bromide (0.1 mg/kg).
- BP, TcPO2, and CBFV were monitored during radial artery blood gas sampling and head ultrasonography/Doppler procedures before and during pancuronium therapy.
Main Results:
- Pancuronium significantly reduced BP increases during blood gas sampling (32% vs. 21%) and ultrasonography.
- Mean TcPO2 changes were significantly improved with pancuronium (-30% vs. 5.8%).
- Coefficients of variation for systolic and mean CBFV decreased significantly during pancuronium therapy.
Conclusions:
- Pancuronium demonstrated short-term benefits in stabilizing vascular dynamics and oxygenation during common nursery procedures in premature infants.
- Further research is needed to evaluate pancuronium's potential role in preventing IVH in mechanically ventilated preterm neonates.
Abstract:
Intermittent increases in blood pressure (BP) associated with motor activity have been implicated in the pathogenesis of intraventricular hemorrhage in premature infants. Inhibition of motor activity by pancuronium administration has also been shown to stabilize cerebral blood flow velocity (CBFV) and BP patterns. The purpose of this study was to determine whether administration of pancuronium to ill premature infants would attenuate changes in BP and transcutaneous oxygen tension (TcPO2) and the variability of CBFV pattern associated with common nursery procedures. Fourteen premature infants in the study were given a single dose of pancuronium bromide at a dose of 0.1 mg/kg intravenously. BP and TcPO2 changes were monitored during nursery procedures, that is, during radial artery blood gas sampling and a head ultrasonographic/Doppler procedure, before and during pancuronium therapy. During arterial blood gas sampling, mean percent increase in BP was significantly greater (32% +/- 21%) before pancuronium administration compared with 21% +/- 13% during pancuronium use (p < 0.05). Mean percent changes in TcPO2 were -30% +/- 21% and 5.8% +/- 7.2% before and during pancuronium use, respectively (p < 0.05). Similar significant changes in BP and TcPO2 were observed with a head ultrasonographic/Doppler procedure. Coefficients of variation of systolic and mean CBFV also decreased significantly during pancuronium therapy. We observed short-term benefits with pancuronium use on vascular dynamics and oxygenation during nursery procedures. Further studies are needed to evaluate the use of pancuronium in preterm babies supported by mechanical ventilation during the first few days of life for possible prevention of intraventricular hemorrhage, the pathophysiologic mechanism of which may be related to hemodynamic and biochemical derangement.