Abstract
We report two cases of healthy infants who were given an IV intubating bolus of a nondepolarizing muscle relaxant (0.1 mg · kg−1 vecuronium) at the beginning of an inhalational induction of anaesthesia. Shortly after the introduction of low concentrations of gaseous agents, both infants exhibited airway obstruction although inspiratory muscle activity was still vigorous. The airway obstruction was due to approximation of the tongue to the posterior pharyngeal wall, and was easily corrected by insertion of an oral airway. The infants immediately exhibited fulminant pulmonary oedema, which responded to conventional therapy. It is postulated that paralysis of glossal muscles occurred prior to diaphragmatic paralysis, creating upper airway obstruction while preserving inspiratory muscle activity. This can rapidly lead to negative pressure pulmonary oedema in the small infant. Meticulous attention to the maintenance of an unobstructed upper airway is required if muscle relaxants are administered to the awake infant.
Résumé
Peu aprés l’injection intraveineuse de 0,1 mg · kg−1 de vécuronium en bolus, au debut d’une induction par anesthésique en inhalation, deux bébés en bonne santé développérent une obstruction respiratoire tandis que persistait une activite importante des muscles inspiratoires. Linsertion d’une canule oropharyngée corrigea rapidement l’obstruction causée par l’accolement de la langue à la paroi postérieure du pharynx. Dans les deux cas, il s’ensuivit toutefois un aedème pulmonaire fulminant que l’on traita de façon conventionnelle. Nous postulons que la paralysie des muscles de la langue survint avant celle du diaphragme, amenant une obstruction des voies aériennes sur une mécanique inspiratoire intacte. Chez les bébés, cela peut facilement entraîner un oedème pulmonaire par pression négative. Mieux vaut done s’assurer de la perméabilité des voies aériennes lorsque quon injecte un curare à un enfant éveillé.
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Warner, L.O., Martino, J.D., Davidson, P.J. et al. Negative pressure pulmonary oedema: a potential hazard of muscle relaxants in awake infants. Can J Anaesth 37, 580–583 (1990). https://doi.org/10.1007/BF03006330
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DOI: https://doi.org/10.1007/BF03006330