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Pancuronium Bromide (Continued)

Fredrick K. Orkin, MC
JAMA. 1973;226(2):199. doi:10.1001/jama.1973.03230020044023.
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To the Editor.—  Dr. Foldes (225:418, 1973) recently suggested that the excessive tachycardia noted by Dr. Beam (223:1044, 1973) and myself (224:630, 1973) following use of pancuronium bromide was due to "unnecessarily large doses" of this muscle relaxant, and that the drug should not be used in patients with preexisting tachycardia. Both impressions are without substantiation in the literature.Admittedly, Dr. Beam used very large doses to facilitate mechanical ventilation of an asthmatic child. Yet he was merely guided by the experience of Levin and Dillon (222:1265, 1972) who did not observe excessive tachycardia following similar doses in similar patients. Professor Foldes criticized my use of doses within the range (0.06 to 0.10 mg/kg) recommended by the manufacturer for tracheal intubation, suggesting that 0.06 mg/kg should be adequate. For the sake of brevity in the description of the most prominent tachycardia I observed, I did not mention that the use


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