TETRAPARESIS IN AN INFANT SUBSEQUENT TO L ONG-TERM ADMINISTRATION OF PANCURONIUM IN THE ICU

Long-term administration of pancuronium for ventilatory support of adu lts with ARDS may result in severe tetraparesis, with areflexia and at rophy of distal muscles. This adverse effect occurs rarely in paediatr ic intensive care units, We describe a case of tetraparesis after prol onged pancuronium infusion in a 9-month-old girl who experienced a sev ere bronchopneumonia caused by para-influenza virus, requiring endotra cheal intubation and mechanical ventilation. To decrease chest wall ri gidity, pancuronium was administered over 11 days, with a total dose o f approximately 120 mg of pancuronium bromide. The day after discontin uation of the muscle relaxant she had a severe tetraplegia with arefle xia, but normal head movements. Electromyography showed a normal neuro muscular transmission. She recovered from tetraplegia three months lat er, Other causes of peripheral neuropathy were eliminated, Electroence phalograms and head CT-scans were normal. The recovery pattern observe d in our patient corresponded to the process of regeneration seen afte r axonal degeneration. It is suggested that these neuromuscular compli cations were caused by prolonged high-dosage pancuronium treatment, as sociated with corticosteroid and aminoglycoside administration.