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Canadian Journal of Anesthesia, Vol 37, 580-583, Copyright © 1990 by Canadian Anesthesiologists' Society

ARTICLES

Negative pressure pulmonary oedema: a potential hazard of muscle relaxants in awake infants

LO Warner, JD Martino, PJ Davidson and TP Beach
Department of Anesthesiology, Children's Hospital, Columbus, Ohio.

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.




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Copyright © 1990 by the Canadian Anesthesiologists' Society.