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. 1987 Sep-Oct;34(5):171–176.

Pancuronium Rapid Induction Sequence

W Corbett Holmgreen, Gary Nishioka, R Brian Smith
PMCID: PMC2148540  PMID: 3479916

Abstract

Succinylcholine is traditionally used as the muscle relaxant of choice for rapid induction sequence intubation. There are, however, many absolute and relative contraindications for the use of succinylcholine necessitating the need for an alternative muscle relaxant. This study was undertaken to evaluate the effectiveness of pancuronium bromide for muscle relaxation in the rapid induction sequence in comparison to succinylcholine. A double-blind study was undertaken in 90 patients divided into two groups: One group was intubated at 60 seconds and the other at 90 seconds. Each group was divided into four subgroups by random selection and received of the following regimens: (a) succinylcholine, 1.5 mg/kg preceded by 3 mg of d-tubocurarine; (b) pancuronium bromide, 0.1 mg/kg; (c) pancuronium bromide, 0.125 mg/kg; and (d) pancuronium bromide, 0.15 mg/kg as relaxants in rapid sequence intubation. A rapid sequence intubation was performed with each intubation by a staff member or experienced house officer. Pre- and postinduction blood pressure and heart rate were taken. Postinduction blood gases were taken. The times to completion of intubation were recorded. Cord position, ease of intubation and overall relaxation were evaluated. The results indicate that in experienced hands pancuronium bromide in a dose of 0.1-0.15 mg/kg is as an effective muscle relaxant for rapid induction sequence intubation as is succinylcholine. It is an acceptable alternative when succinylcholine is contraindicated. Intubating conditions are best 90 seconds after the administration of pancuronium bromide.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ANDERSEN N. Changes in intragastric pressure following the administration of suxamethonium. Preliminary report. Br J Anaesth. 1962 Jun;34:363–367. doi: 10.1093/bja/34.6.363. [DOI] [PubMed] [Google Scholar]
  2. BUSH G. H., GRAHAM H. A., LITTLEWOOD A. H., SCOTT L. B. Danger of suxamethonium and endotracheal intubation in anaesthesia for burns. Br Med J. 1962 Oct 27;2(5312):1081–1085. doi: 10.1136/bmj.2.5312.1081. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barr A. M., Thornley B. A. Thiopentone and pancuronium crash induction. A comparison with thiopentone and suxamethonium. Anaesthesia. 1978 Jan;33(1):25–31. doi: 10.1111/j.1365-2044.1978.tb08273.x. [DOI] [PubMed] [Google Scholar]
  4. Barr A. M., Thornley B. A. Thiopentone and suxamethonium crash induction. An assessment of the potential hazards. Anaesthesia. 1976 Jan-Feb;31(1):23–29. doi: 10.1111/j.1365-2044.1976.tb11741.x. [DOI] [PubMed] [Google Scholar]
  5. Brodsky J. B., Brock-Utne J. G., Samuels S. I. Pancuronium pretreatment and post-succinylcholine myalgias. Anesthesiology. 1979 Sep;51(3):259–261. doi: 10.1097/00000542-197909000-00017. [DOI] [PubMed] [Google Scholar]
  6. Brown E. M., Krishnaprasad D., Smiler B. G. Pancuronium for rapid induction technique for tracheal intubation. Can Anaesth Soc J. 1979 Nov;26(6):489–491. doi: 10.1007/BF03006163. [DOI] [PubMed] [Google Scholar]
  7. Chaouki K., Viljoen J. F., Kellner G. A. Pancuronium bromide--a new non-depolarizing muscle relaxant; preliminary report on its use in fifty patients. Cleve Clin Q. 1970 Jul;37(3):133–137. doi: 10.3949/ccjm.37.3.133. [DOI] [PubMed] [Google Scholar]
  8. Chatterjee S. C. Pancuronium bromide in emergency surgery. Anaesthesia. 1976 Jun;31(5):694–698. doi: 10.1111/j.1365-2044.1976.tb11852.x. [DOI] [PubMed] [Google Scholar]
  9. GALINDO A. H., DAVIS T. B. Succinylcholine and cardiac excitability. Anesthesiology. 1962 Jan-Feb;23:32–40. doi: 10.1097/00000542-196201000-00006. [DOI] [PubMed] [Google Scholar]
  10. Gronert G. A., Dotin L. N., Ritchey C. R., Mason A. D., Jr Succinylcholine-induced hyperkalemia in burned patients. II. Anesth Analg. 1969 Nov-Dec;48(6):958–962. [PubMed] [Google Scholar]
  11. HALLDIN M., WAHLIN A. Effect of succinylcholine on the intraspinal fluid pressure. Acta Anaesthesiol Scand. 1959;3:155–161. doi: 10.1111/j.1399-6576.1959.tb00015.x. [DOI] [PubMed] [Google Scholar]
  12. Hey V. M. Relaxants for endotracheal intubation. A comparison of depolarizing and non-depolarizing neuromuscular blocking agents. Anaesthesia. 1973 Jan;28(1):32–36. doi: 10.1111/j.1365-2044.1973.tb00281.x. [DOI] [PubMed] [Google Scholar]
  13. Howardy-Hansen P., Jørgensen B. C., Ording H., Viby-Mogensen J. Pretreatment with non-depolarizing muscle relaxants: the influence on neuromuscular transmission and pulmonary function. Acta Anaesthesiol Scand. 1980 Oct;24(5):419–422. doi: 10.1111/j.1399-6576.1980.tb01575.x. [DOI] [PubMed] [Google Scholar]
  14. Joseph D., Bookallil M. Clinical comparison of tubocurarine and pancuronium. Anaesth Intensive Care. 1972 Aug;1(1):75–78. doi: 10.1177/0310057X7200100111. [DOI] [PubMed] [Google Scholar]
  15. Kelman G. R., Kennedy B. R. Cardiovascular effects of pancuronium in man. Br J Anaesth. 1971 Apr;43(4):335–338. doi: 10.1093/bja/43.4.335. [DOI] [PubMed] [Google Scholar]
  16. Koide M., Waud B. E. Serum potassium concentrations after succinylcholine in patients with renal failure. Anesthesiology. 1972 Feb;36(2):142–145. doi: 10.1097/00000542-197202000-00013. [DOI] [PubMed] [Google Scholar]
  17. Kunjappan V. E., Brown E. M., Alexander G. D. Rapid sequence induction using vecuronium. Anesth Analg. 1986 May;65(5):503–506. [PubMed] [Google Scholar]
  18. LINCOFF H. A., ELLIS C. H., DEVOE A. G., DEBEER E. J., IMPASTATO D. J., BERG S., ORKIN L., MAGDA H. The effect of succinylcholine on intraocular pressure. Am J Ophthalmol. 1955 Oct;40(4):501–510. doi: 10.1016/0002-9394(55)90552-3. [DOI] [PubMed] [Google Scholar]
  19. Lennon R. L., Olson R. A., Gronert G. A. Atracurium or vecuronium for rapid sequence endotracheal intubation. Anesthesiology. 1986 Apr;64(4):510–513. doi: 10.1097/00000542-198604000-00018. [DOI] [PubMed] [Google Scholar]
  20. Loh L. The cardiovascular effects of pancuronium bromide. Anaesthesia. 1970 Jul;25(3):356–363. doi: 10.1111/j.1365-2044.1970.tb00221.x. [DOI] [PubMed] [Google Scholar]
  21. MASTERS F. W., HANSEN J. M., ROBINSON D. W. Anesthetic complications in plastic surgery. Plast Reconstr Surg Transplant Bull. 1959 Nov;24:472–480. doi: 10.1097/00006534-195911000-00004. [DOI] [PubMed] [Google Scholar]
  22. McLeskey C. H., McLeod D. S., Hough T. L., Stallworth J. M. Prolonged asystole after succinylcholine administration. Anesthesiology. 1978 Sep;49(3):208–210. doi: 10.1097/00000542-197809000-00012. [DOI] [PubMed] [Google Scholar]
  23. Mehta M. P., Choi W. W., Gergis S. D., Sokoll M. D., Adolphson A. J. Facilitation of rapid endotracheal intubations with divided doses of nondepolarizing neuromuscular blocking drugs. Anesthesiology. 1985 Apr;62(4):392–395. doi: 10.1097/00000542-198504000-00005. [DOI] [PubMed] [Google Scholar]
  24. Meyers E. F., Krupin T., Johnson M., Zink H. Failure of nondepolarizing neuromuscular blockers to inhibit succinylcholine-induced increased intraocular pressure, a controlled study. Anesthesiology. 1978 Feb;48(2):149–151. doi: 10.1097/00000542-197802000-00013. [DOI] [PubMed] [Google Scholar]
  25. Miller R. D., Way W. L., Hamilton W. K., Layzer R. B. Succinylcholine-induced hyperkalemia in patients with renal failure? Anesthesiology. 1972 Feb;36(2):138–141. doi: 10.1097/00000542-197202000-00011. [DOI] [PubMed] [Google Scholar]
  26. Miller R. D., Way W. L. Inhibition of succinylcholine-induced increased intragastric pressure by nondepolarizing muscle relaxants and lidocaine. Anesthesiology. 1971 Feb;34(2):185–188. doi: 10.1097/00000542-197102000-00026. [DOI] [PubMed] [Google Scholar]
  27. Mitchell M. M., Ali H. H., Savarese J. J. Myotonia and neuromuscular blocking agents. Anesthesiology. 1978 Jul;49(1):44–48. doi: 10.1097/00000542-197807000-00014. [DOI] [PubMed] [Google Scholar]
  28. Naguib M., Gyasi H. K., Abdulatif M., Absood G. H. Rapid tracheal intubation with atracurium--a comparison of priming intervals. Can Anaesth Soc J. 1986 Mar;33(2):150–156. doi: 10.1007/BF03010824. [DOI] [PubMed] [Google Scholar]
  29. Pandey K., Badola R. P., Kumar S. Time course of intraocular hypertension produced by suxamethonium. Br J Anaesth. 1972 Feb;44(2):191–196. doi: 10.1093/bja/44.2.191. [DOI] [PubMed] [Google Scholar]
  30. ROE R. B. The effect of suxamethonium on intragastric pressure. Anaesthesia. 1962 Apr;17:179–181. doi: 10.1111/j.1365-2044.1962.tb13450.x. [DOI] [PubMed] [Google Scholar]
  31. Roth F., Wüthrich H. The clinical importance of hyperkalaemia following suxamethonium administration. Br J Anaesth. 1969 Apr;41(4):311–316. doi: 10.1093/bja/41.4.311. [DOI] [PubMed] [Google Scholar]
  32. Schaner P. J., Brown R. L., Kirksey T. D., Gunther R. C., Ritchey C. R., Gronert G. A. Succinylcholine-induced hyperkalemia in burned patients. 1. Anesth Analg. 1969 Sep-Oct;48(5):764–770. [PubMed] [Google Scholar]
  33. Schwarz S., Ilias W., Lackner F., Mayrhofer O., Foldes F. F. Rapid tracheal intubation with vecuronium: the priming principle. Anesthesiology. 1985 Apr;62(4):388–391. doi: 10.1097/00000542-198504000-00004. [DOI] [PubMed] [Google Scholar]
  34. Taboada J. A., Rupp S. M., Miller R. D. Refining the priming principle for vecuronium during rapid-sequence induction of anesthesia. Anesthesiology. 1986 Feb;64(2):243–247. doi: 10.1097/00000542-198602000-00019. [DOI] [PubMed] [Google Scholar]
  35. Vaughan R. W., Cobb M. L. Pancuronium bromide as the sole muscle relaxant for major surgery. Anesth Analg. 1974 Jan-Feb;53(1):56–63. [PubMed] [Google Scholar]
  36. Waters D. J., Mapleson W. W. Suxamethonium pains: hypothesis and observation. Anaesthesia. 1971 Apr;26(2):127–141. doi: 10.1111/j.1365-2044.1971.tb04753.x. [DOI] [PubMed] [Google Scholar]

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