Pancuronium Bromide (Continued)

To the Editor.— In reference to the LETTER TO THE EDITOR by Beam (223:1044, 1973) we want to state that 0.2 mg/kg pancuronium bromide used by this correspondent as an initial dose to facilitate controlled ventilation is never indicated and reveals a complete lack of familiarity with the clinical pharmacology of pancuronium. The mean dose that caused 100% neuromuscular blockade in the hand muscles in our dose-finding study in 30 adult patients anesthetized by thiamylal-nitrous oxide-oxygen was 0.076 mg/kg, intravenously.1In clinical practice, only 60% to 70% of the complete paralyzing dose is usually required for the facilitation of endotracheal intubation. Certainly, no greater dose is ever necessary for facilitation of assisted or controlled ventilation. The incremental doses of pancuronium were also disproportionate to the need. In our study,1we found that one fourth to one third of the initial relaxant doses (0.02 mg/kg intravenously) of pancuronium bromide