Controlled Evaluation of Muscle Relaxation in the Ventilated Neonate

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Abstract
To assess the effects of muscle relaxation on the critically ill ventilated neonate, pancuronium bromide was administered for 12 h to 10 low birth weight neonates (960-2000 g) of 26-34 wk gestation, all of whom required mechanical ventilation and were studied within 48 h of birth (6-39 h). The infants were also studied for 12 h during which no pancuronium bromide was administered. During both periods, the order of which was random, heart rate, blood pressure, PO2 [partial pressure of O2] and intracranial pressure were continuously measured. The amounts of handling during the pancuronium and control periods were similar. The results revealed a significantly greater duration of hypoxia (PO2 < 50 torr) (56.1 vs. 23.6 min, P < 0.001) and hyperoxia (PO2 > 70 torr) during the control period (92.5 vs. 13 min, P < 0.001). Durations of intracranial pressure elevation 10 cm H2O above the infant''s baseline were significantly less during paralysis (6.7 vs. 58.8 min, P < 0.001) as were spikes of intracranial pressure to > 25 cm H2O (1.6 vs. 24.4, P < 0.05). There was no significant improvement in blood gas values, fractional inspiratory O2 or ventilatory settings during muscle relaxation. Pancuronium reduced periods of nonoptimal oxygenation and elevated intracranial pressure and may help to decrease adverse sequelae for the low birth weight ventilated neonate.