Development of resistance to pancuronium in adult respiratory distress syndrome.

Muscle relaxants are being used not only more frequently but also for longer periods as improved techniques in mechanical ventilation produce longer survival of patients with severe respiratory disease. I t is often helpful to these patients both to minimize their work of breathing in order to decrease oxygen consumption and to decrease the inflating pressures generated in order to possibly lower the risk of barotrauma (1). Typically, repeated doses or continuous infusions of a nondepolarizing muscle relaxant such as pancuronium have been effective in providing paralysis of the respiratory muscles (2). In this report, I present the case of a patient who became unresponsive to the muscle relaxant effects of pancuronium on the sixth day it was used.