Tetraparesis in an infant after prolonged administration of pancuronium

• Published in: Annales françaises d'anesthésie et de réanimation Vol. 14; no. 5; p. 426
• Main Authors: Bordet, F, Contamin, B, Berthier, J C, Rousson, A, Pondarre, C
• Format: Journal Article
• Language: French
• Published: France 1995
• Subjects: Bronchopneumonia - therapy; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Neuromuscular Diseases - chemically induced; Neuromuscular Nondepolarizing Agents - administration & dosage; Neuromuscular Nondepolarizing Agents - adverse effects; Pancuronium - administration & dosage; Pancuronium - adverse effects; Quadriplegia - chemically induced; Respiration, Artificial; Respiratory Distress Syndrome, Newborn - therapy
• ISSN: 0750-7658

Long-term administration of pancuronium for ventilatory support of adults with ARDS may result in severe tetraparesis, with areflexia and atrophy of distal muscles. This adverse effect occurs rarely in paediatric intensive care units. We describe a case of tetraparesis after prolonged pancuronium infusion in a 9-month-old girl who experienced a severe bronchopneumonia caused by para-influenza virus, requiring endotracheal intubation and mechanical ventilation. To decrease chest wall rigidity, pancuronium was administered over 11 days, with a total dose of approximately 120 mg of pancuronium bromide. The day after discontinuation of the muscle relaxant she had a severe tetraplegia with areflexia, but normal head movements. Electromyography showed a normal neuromuscular transmission. She recovered from tetraplegia three months later. Other causes of peripheral neuropathy were eliminated. Electroencephalograms and head CT-scans were normal. The recovery pattern observed in our patient corresponded to the process of regeneration seen after axonal degeneration. It is suggested that these neuromuscular complications were caused by prolonged high-dosage pancuronium treatment, associated with corticosteroid and aminoglycoside administration.