1598 MUSCLE RELAXANTS-A POTENTIAL DANGER TO INFANTS AT RISK FOR INTRAVENTRICULAR HEMORHAGE

Abstract

Goldberg recently reported an increased incidence of intraventricular hemorrhage(IVH) in infants receiving muscle relaxants(MR). The mechanism is unknown. We studied 11 infants (BW 850-2800gm) before and during administration of curare or pancuronium. The effects of an increase of 4cm. peak inspiratory pressure (↑PIP) and of leg raising(LR) were tested. Intracranial pressure(ICP) was measured. Cerebral blood flow (CBF) was assessed by a doppler technique and expressed as pulsatility index (PI=systolic-diastolic/systolic) (Bada). Our results (Mean±SD):

During MR, PI decreased, consistent with an increase in apparent CBF. There was no significant change in ICP due to MR alone. However, there was a significantly greater increase in ICP during ↑PIP and LR. Both observations suggest a loss of autoregulation during MR.

We conclude, muscle relaxants affect cerebrovascular dqnamics and may be dangerous in infants at risk for IVH, particularly when high PIP is required.

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