Effect of priming dose of vecuronium on lung function in elderly patients

We questioned whether the side effects outweighed the advantages of priming doses of nondepolarizing neuromuscular relaxants in awake patients. We have assessed lung function and clinical evidence of muscle weakness in 10 elderly patients, eight women and two men, aged 67-78 yr, ASA grade I or II, before and 3 min after a priming dose (0.01 mg/kg) of vecuronium. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), maximum midexpiratory flow rate (MMEF), peak expiratory flow rate (PEFR), inspiratory capacity (IC), functional residual capacity (FRC), expiratory reserve volume (ERV), residual volume (RV), slow vital capacity (SVC), and total lung capacity (TLC) were measured by using a Morgan transfer test machine and oxygen saturation (SpO2) was measured by pulse oximetry. All the patients developed ptosis, six had diplopia and were unable to perform the Valsalva maneuver for 10s, and four were unable to swallow or lift their head for > 4s, demonstrating significant muscle weakness. Significant reductions occurred in FVC, FEV1, FRC, ERV, SVC, and TLC. SpO2 decreased in 8 of 10 patients, and in 4 the decrease exceeded 4%. We conclude that priming with vecuronium 0.01 mg/kg in elderly patients causes significant impairment of lung function and a significant decrease in oxygen saturation.