Pancuronium Midazolam

General anesthetics are rarely given alone. In addition to the analgesic agents just mentioned, benzodiazepines (midazolam, Versed diazepam, Valium ) are commonly used as adjuncts for the relief of anxiety, amnesia, and sedation prior to induction of anesthesia. Neuromuscular blockers (e.g., succinylcholine or pancuronium) can also be administered during the induction of anesthesia to relax skeletal muscles. 

In 113 patients undergoing general anesthesia, intravenous midazolam 15 mg slowed recovery of the twitch height after vecuronium and atracurium compared with diazepam. The recovery index was not altered (162). However, in another study in 20 patients, midazolam 0.3 mg/kg did not affect the duration of blockade, recovery time, intensity of fasciculations, or adequacy of relaxation for tracheal intubation produced by suxamethonium 1 mg/kg, nor the duration of blockade and adequacy of relaxation for tracheal intubation produced by pancuronium 0.025 mg/kg in incremental doses until 99% depression of muscle-twitch tension was obtained (161). Furthermore, in 60 patients undergoing maintenance anesthesia randomly assigned to one of six regimens (etomidate, fentanyl, midazolam, propofol, thiopental plus nitrous oxide, or isoflurane plus nitrous oxide), midazolam did not alter rocuronium dosage requirements (165). 

Cronnelly R, Morris RB, Miller RD. Comparison of thiopental and midazolam on the neuromuscular responses to succinylcholine or pancuronium in humans. Anesth Analg 1983 62(l) 75-7. 

Avoid imnecessary stimulation, which may induce rigidity and spasms. The primary treatment for spasms and rigidity is sedation with a benzodiazepine, such as midazolam or diazepam. Additional sedation may be provided with propofol or a phenothiazine, usually chlorpromazine. In severe disease prolonged spasms and respiratory dys-fimction will necessitate tracheal intubation and mechanical ventilation will be required. If the patient has been intubated and sedation alone is inadequate to control spasms, a neuromuscular blocking drug, e.g., intermittent doses of pancuronium or a continuous infusion of atracurium, will be required. 

Boulieu, R. Bonnefous, J.L. Ferry, S. Solid-phase extraction of diltieizem and its metabolites from plasma prior to hi -performance liquid chromatography. J.Chromatogr., 1990, 528, 542-546 [plasma propionyldeacetyldiltiazem (IS) SPE extracted metabolites LOD 0.3 ng non-interfering diazepeun, ilunitreizepam, midazolam, nifedipine, pancuronium bromide, procainamide, propranolol, quinidine, verapamil]... 

In other studies diazepam was found to have no significant effect on the neuromuscular blockade due to alcuronium, atracurium, gaiiamine, pancuronium, suxamethonium " or tubocurarine. " " Lo-razepam and lormetazepam have been reported to have little or no effects on atracurium or vecuronium, and midazolam has been reported to have no eftect on suxamethonium or pancuronium. ... 

Noninterfering alfentanil, aprotinin, atropine, bupivacaine, chlorpromazine, dalteparin, dexamethasone, diazepam, dopamine, droperidol, etomidate, fentanyl, furosemide, gallamine, haloperidol, midazolam, morphine, neostigmine, nitroglycerin, nitroprusside, oxytocin, pancuronium, pentobarbital, phenylephrine, phenytoin, pipecuronium, piperacillin, promethazine, propofol, ranitidine, succinylcholine, sufentanil, terbutaline, thiopental, vecuronium, verapamil... 

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