Prolonged paralysis associated with long-term pancuronium use.
We cared for a 4-year-old patient who had undergone orthotopic liver transplantation and was placed on a ventilator for respiratory distress associated with Pneumocystis carinii pneumonia. The neuromuscular blocking agent pancuronium bromide 1.0-1.2 mg every hour as needed was used to facilitate artificial ventilation for 40 days. On discontinuation of pancuronium, the patient experienced severe, generalized neuromuscular dysfunction. Because no improvement was seen for 2 weeks, the acetylcholinesterase inhibitors edrophonium and pyridostigmine were instituted. Shortly thereafter the patient's condition began to improve. Gradual improvement occurred over 3-4 months and the patient has since returned to baseline neurologic function. We suggest that long-term pancuronium use was the cause of the patient's prolonged paralysis. The improvement experienced after the initiation of antidotal therapy strongly supports our proposal.
Haas
J L
JL
Department of Pharmacy Practice, University of Nebraska Medical CenterOhama 68105.
Shaefer
M S
MS
Miwa
L J
LJ
Wood
R P
RP
Shaw
B W
BW
D002675:Child, Preschool; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D010197:Pancuronium / Q000009:adverse effects*; D010243:Paralysis / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology
D002800:Cholinesterase Inhibitors; D010197:Pancuronium