Pancuronium

 Risk Factor: CM
 Class: AUTONOMICS / Skeletal Muscle Relaxants

Contents of this page:

Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

Pancuronium (pancuronium bromide) is a competitive (nondepolarizing) neuromuscular blocking agent. Structurally, it is a bisquaternary ammonium compound (i.e., contains two quaternary ammonium groups) and is commercially available as the dibromide. Pancuronium is used to induce skeletal muscle relaxation during anesthesia and other procedures, and has been used to produce fetal muscle paralysis during intrauterine procedures.

Unpublished reproduction studies in rats and rabbits with pancuronium did not reveal any effect on the number of resorptions, litter size, birth weight and vitality, or the frequency of malformations (gross, skeletal, and internal organs) (1). Pregnant rats (average gestational length 2122 days [2]) received intraperitoneal doses of 0.16 mg/kg/day either from the 7th to the 14th day or from the 1st to the 20th day of gestation, whereas pregnant rabbits (average gestational length 3134 days [2]) were given IV doses of 0.02 mg/kg/day from day 8 to day 16 of gestation.

Theoretically, the combination of relatively high molecular weight (about 733 for the dibromide) and the presence of two quaternary ammonium groups that are ionized at physiologic pH should limit the placental transfer of pancuronium. An animal study, published in 1973, appeared to confirm the lack of significant transfer when cumulative IV doses up to 16.3 mg/kg administered to pregnant ferrets (neuromuscular block in the mother complete at 0.015 mg/kg) did not cause neuromuscular blockade in the fetus during a 1-hour observation period (3). The fetus was responsive to pancuronium-induced blockade by direct administration. Further, the lack of adverse effects in newborns after mean doses of 0.0875 mg/kg at cesarean section led some authors to conclude that the drug did not cross the placenta (4). However, several human studies have demonstrated placental transfer, at least near term, when pancuronium was used during cesarean section (5,6,7,8,9,10 and 11).

Maternal IV bolus doses between 0.04 mg/kg and 0.12 mg/kg (approximately 2.88.6 times the maternal ED50, the dose producing a 50% depression of evoked twitch tension [12]), resulted in mean umbilical vein:maternal vein ratios ranging from 0.19 to 0.26. These ratios were higher than those measured with atracurium, fazadinium, pipecuronium, rocuronium, d-tubocurarine, and vecuronium (13). No clinical evidence of neuromuscular blockade was observed in five studies in which the neonatal condition was noted (5,6,7,8 and 9), but in one of the studies (9) the Neurologic and Adaptive Capacity Scores (NACS) system indicated that neonatal depression was present. The NACS evaluates adaptive capacity, passive and active muscular tone, primary reflexes, and general assessment (13). The maximum score possible is 40, with a score of 3540 denoting a normal, vigorous baby.

The NACS was measured at 15 minutes, 2 hours, and 24 hours in seven newborns whose mothers had been given IV doses of d-tubocurarine (3 mg), thiopental (4 mg/kg), succinylcholine (1.5 mg/kg), and pancuronium (0.04 mg/kg) immediately prior to cesarean section (9). Five newborns (71%) had a NACS value <35 at 15 minutes, three were <35 at 2 hours, and none were <35 at 24 hours (9). Although the NACS indicated depression, no neonatal adverse effects were actually observed (9). A 1998 review, commenting on this and other studies of neuromuscular relaxants in pregnancy, thought the low NACS values may have been caused by a contribution from the other anesthetic agents (13).

The direct administration of pancuronium has been reported in animals and humans (14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29, 30,31,32,33,34,35,36,37 and 38) . A 1989 report compared the effects of pancuronium (0.5 mg/kg IV over 5 minutes) and d-tubocurarine (3.0 mg/kg IV over 5 minutes) on the heart rate and mean arterial pressure of fetal lambs (14). Whereas pancuronium significantly increased both rate and pressure, both measures were significantly decreased by d-tubocurarine. Only pancuronium effected fetal pH and Pco2, increasing the former and decreasing the latter. The human studies, discussed below, all involve pancuronium administration during the second half of gestation.

In a study published in 1988, the baseline fetal heart rate (FHR), number of accelerations, and beat-to-beat variability were assessed before and after an IV bolus dose of pancuronium (0.050.10 mg/kg) was given to 17 fetuses before transfusion (15). Twenty minutes after transfusion, no changes were noted in the baseline FHR, although some heart rate patterns appeared sinusoidal-like, but significant decreases in accelerations (p=0.003) and variability (p=0.0003) were observed (15). The transient FHR changes were not indicative of fetal compromise and returned to normal when the fetus awakened (15). A 1991 abstract reported significantly less bradycardia with the use of pancuronium (0.3 mg/kg) compared with no muscle relaxant after cordocentesis (3.6% [8/224] vs. 8.2% [27/329], p=0.04) and a near significant difference after intravascular transfusion (7.9% [9/114] vs. 40% [2/5], p=0.06) (16).

Pancuronium (0.1 mg/kg IV) was administered to 20 fetuses immediately before blood transfusion at 28 to 34 weeks' gestation (17). A control group of 20 fetuses matched for gestational age and hematocrit who did not receive pancuronium was used for comparison. After transfusion, compared with controls, fetuses that received pancuronium had significantly fewer FHR accelerations (mean 0 vs. 3.0, p<0.0005), less change in the baseline FHR (increase 1.5 beats per minute [bpm] vs. decrease 4 bpm, p<0.0005), lower mean minute range in FHR variation (17.3 vs. 34.7, p<0.0001), and less short-term variation (3.4 vs. 7.35, p=0.0001). Another study compared FHR changes after the use of pancuronium or vecuronium for intravascular transfusion, fetal thoracentesis, or paracentesis (18). Specific details were not provided for the pancuronium group, but the authors concluded that the pancuronium-induced increase in FHR and decrease in variability made it less desirable than vecuronium, which caused no FHR changes.

Fetal death at 25.5 weeks' gestation, that was apparently the result of a cord hematoma, occurred 2 hours after an intravascular intrauterine transfusion (19). The authors thought that the accident was related to the injection of pancuronium before confirmation of needle placement by aspiration of fetal blood. The results of an autopsy confirmed that the cause of death was compression of the umbilical vein by the hematoma with subsequent umbilical venous thrombosis.

Fetal administration of pancuronium immediately preceding magnetic resonance imaging (MRI) has been described in a number of publications (20,21,22,23,24,25,26,27 and 28). Most used doses varying from 0.08 to 0.3 mg/kg (IV into the umbilical vein or IM) (20,21,22,23,24 and 25), two used 0.5 mg IM (26,27), and one reported 100 mg (sic) into the intrahepatic vein of each twin (28).

Direct fetal administration of pancuronium for intrauterine procedures, such as cordocentesis and intravascular transfusion, has been reported (29,30,31,32,33,34,35,36,37 and 38). The fetal dose ranged from 0.1 to 0.3 mg/kg IV or IM, but in one report a single 0.5-mg IM dose was administered (29). In another study, pancuronium (0.15 mg/kg of the estimated total fetal body weights of twins) was administered in two cases to the smaller of a set of twins (38). The procedure was undertaken in an attempt to diagnose twin-twin transfusion syndrome. In the first case, the FHR patterns of both twins showed lack of accelerations and decreased variability and, in addition, the larger twin had a sinusoidal-like pattern. In the second case, absent accelerations and decreased variability occurred only in the smaller twin (38).

A continuous infusion of morphine, midazolam, and pancuronium was administered for 10 hours to allow mechanical ventilation in a seriously ill, pregnant (about 35 weeks') woman with pneumonia due to Legionella pneumophila (39). No evidence of fetal harm was observed during the infusion, but the fetus was noted to have a consistent pattern of sleeping. Approximately 3 to 4 weeks later, at 40 weeks' gestation, the mother gave birth to a healthy female infant.

In summary, pancuronium has been administered directly to the fetus during the last half of pregnancy and to the mother at cesarean section without causing fetal harm. Although no teratogenicity was observed in two animal species, the use of pancuronium in early human pregnancy has not been reported. The drug is known to cross the human placenta to the fetus, at least near term. Placental transfer early in pregnancy has not been reported. Large or repetitive doses and/or prolonged dose-to-delivery intervals may potentially result in newborn depression, but the clinical significance of this appears to be low. Moreover, other anesthetic agents may contribute to the condition. In addition, transient FHR changes, such as decreased accelerations and beat-to-beat variability, and an occasional sinusoidal-like pattern, have been observed after direct fetal administration, but apparently this does not indicate fetal compromise.

Breast Feeding Summary

No reports describing the use of pancuronium in a lactating woman have been located. Because of the nature of the drug and its indications, such reports are unlikely to occur. Moreover, because pancuronium is a bisquaternary ammonium compound, it is ionized at physiologic pH. Only the nonionized form would be available for excretion into milk, and this would probably be only trace amounts (40). In addition, compounds of this type are poorly absorbed from the gastrointestinal tract (40).

References

1. Speight TM, Avery GS. Pancuronium bromide: A review of its pharmacological properties and clinical application. Drugs 1972;4:163226.
2. Shepard TH. Catalog of Teratogenic Agents. 9th ed. Baltimore, MD: Johns Hopkins University Press, 1998.
3. Evans CA, Waud DR. Do maternally administered neuromuscular blocking agents interfere with fetal neuromuscular transmission? Anesth Analg 1973;52:54852.
4. Neeld JB Jr, Seabrook PD Jr, Chastain GM, Frederickson EL. A clinical comparison of pancuronium and tubocurarine for cesarean section anesthesia. Anest Analg 1974;53:711.
5. Speirs I, Sim AW. The placental transfer of pancuronium bromide. Br J Anaesth 1972;44:3703.
6. Booth PN, Watson MJ, McLeod K. Pancuronium and the placental barrier. Anaesthesia 1977;32:3203.
7. Duvaldestin P, Demetriou M, Henzel D, Desmonts JM. The placental transfer of pancuronium and its pharmacokinetics during caesarian section. Acta Anaesthiol Scand 1978;22:32733.
8. Abouleish E, Wingard LB Jr, De La Vega S, Uy N. Pancuronium in caesarean section and its placental transfer. Br J Anaesth 1980;52:5316.
9. Dailey PA, Fisher DM, Shnider SM, Baysinger CL, Shinohara Y, Miller RD, Abboud TK, Kim KC. Pharmacokinetics, placental transfer, and neonatal effects of vecuronium and pancuronium administered during cesarean section. Anesthesiology 1984;60:56974.
10. Heaney GAH. Pancuronium in maternal and foetal serum. Br J Anaesth 1974;46:2827.
11. Wingard LB Jr, Abouleish E, West DC, Goehl TJ. Modified fluorometric quantitation of pancuronium bromide and metabolites in human maternal and umbilical serums. J Pharm Sci 1979;68:9145.
12. Agoston S, Crul JF, Kersten UW, Scaf AHJ. Relationship of the serum concentration of pancuronium to its neuromuscular activity in man. Anesthesiology 1977;47:50912.
13. Guay J, Grenier Y, Varin F. Clinical pharmacokinetics of neuromuscular relaxants in pregnancy. Clin Pharmacokinet 1998;34:48396.
14. Chestnut DH, Weiner CP, Thompson CS, McLaughlin GL. Intravenous administration of d-tubocurarine and pancuronium in fetal lambs. Am J Obstet Gynecol 1989;160:5103.
15. Pielet BW, Socol ML, MacGregor SN, Dooley SL, Minogue J. Fetal heart rate changes after fetal intravascular treatment with pancuronium bromide. Am J Obstet Gynecol 1988;159:6403.
16. Weiner C. Pancuronium protects against fetal bradycardia following umbilical cord puncture (abstract). Am J Obstet Gynecol 1991;164:335.
17. Spencer JAD, Ronderos-Dumit D, Rodeck CH. The effect of neuromuscular blockade on human fetal heart rate and its variation. Br J Obstet Gynaecol 1994;101:1214.
18. Watson WJ, Atchison SR, Harlass FE. Comparison of pancuronium and vecuronium for fetal neuromuscular blockade during invasive procedures. J Matern Fetal Med 1996;5:1514.
19. Seeds JW, Chescheir NC, Bowes WA Jr, Owl-Smith FA. Fetal death as a complication of intrauterine intravascular transfusion. Obstet Gynecol 1989;74:4613.
20. Williamson RA, Weiner CP, Yuh WTC, Abu-Yousef MM. Magnetic resonance imaging of anomalous fetuses. Obstet Gynecol 1989;73:9526.
21. Lituania M, Passamonti U, Cordone MS, Magnano GM, Toma P. Schizencephaly: prenatal diagnosis by computed sonography and magnetic resonance imaging. Prenat Diagn 1989;9:64955.
22. Toma P, Lucigrai G, Dodero P, Lituania M. Prenatal detection of an abdominal mass by MR imaging performed while the fetus is immobilized with pancuronium bromide. AJR 1990;154:104950.
23. Toma P, Costa A, Magnano GM, Cariati M, Lituania M. Holoprosencephaly: prenatal diagnosis by sonography and magnetic resonance imaging. Prenat Diagn 1990;10:42936.
24. Wenstrom KD, Williamson RA, Weiner CP, Sipes SL, Yuh WTC. Magnetic resonance imaging of fetuses with intracranial defects. Obstet Gynecol 1991;77:52932.
25. Okamura K, Murotsuki J, Sakai T, Matsumoto K, Shirane R, Yajima A. Prenatal diagnosis of lissencephaly by magnetic resonance image. Fetal Diagn Ther 1993;8:569.
26. Lenke RR, Persutte WH, Nemes JM. Use of pancuronium bromide to inhibit fetal movement during magnetic resonance imaging. A case report. J Reprod Med 1989;34:3157.
27. Horvath L, Seeds JW. Temporary arrest of fetal movement with pancuronium bromide to enable antenatal magnetic resonance imaging of holoprosencephaly. Am J Perinatol 1989;6:41820.
28. Zoppini C, Vanzulli A, Kustermann A, Rizzuti T, Selicorni A, Nicolini U. Prenatal diagnosis of anatomical connections in conjoined twins by use of contrast magnetic resonance imaging. Prenat Diag 1993;13:9959.
29. Seeds JW, Corke BC, Spielman FJ. Prevention of fetal movement during invasive procedures with pancuronium bromide. Am J Obstet Gynecol 1986;155:8189.
30. Moise KJ Jr, Carpenter RJ Jr, Deter RL, Kirshon B, Diaz SF. The use of neuromuscular blockade during intrauterine procedures. Am J Obstet Gynecol 1987;157:8749.
31. Copel JA, Grannum PA, Harrison D, Hobbins JC. The use of intravenous pancuronium bromide to produce fetal paralysis during intravascular transfusion. Am J Obstet Gynecol 1988;158:1701.
32. Moise KJ Jr, Deter RL, Kirshon B, Adam K, Patton DE, Carpenter RJ Jr. intravenous pancuronium bromide for fetal neuromuscular blockade during intrauterine transfusion for red-cell alloimmunization. Obstet Gynecol 1989;74:9058.
33. Fan SZ, Huang, FY, Lin SY, Wang YP, Hsieh FJ. Intrauterine neuromuscular blockade in fetus. Anaesth Sinica 1990;28:314.
34. Weiner CP, Wenstrom KD, Sipes SL, Williamson RA. Risk factors for cordocentesis and fetal intravascular transfusion. Am J Obstet Gynecol 1991;165:10205.
35. Fan SZ, Susetio L, Tsai MC. Neuromuscular blockade of the fetus with pancuronium or pipecuronium for intra-uterine procedures. Anaesthesia 1994;49:2846.
36. Mouw RJC, Hermans J, Brandenburg HCR, Kanhai HHH. Effects of pancuronium or atracurium on the anemic fetus during and directly after intrauterine transfusion (IUT): a double blind randomized study (abstract). Am J Obstet Gynecol 1997;176:S18.
37. Mouw RJC, Klumper F, Hermans J, Brandenburg HCR, Kanhai HHH. Effect of atracurium or pancuronium on the anemic fetus during and directly after intravascular intrauterine transfusion. A double blind randomized study. Acta Obstet Gynecol Scand 1999;78:7637.
38. Tanaka M, Natori M, Ishimoto H, Kohno H, Kobayashi T, Nozawa S. Intravascular pancuronium bromide infusion for prenatal diagnosis of twin-twin transfusion syndrome. Fetal Diagn Ther 1992;7:3640.
39. Eisenberg VH, Eidelman LA, Arbel R, Ezra Y. Legionnaire's disease during pregnancy: a case presentation and review of the literature. Eur J Obstet Gynecol Reprod Biol 1997;72:158.
40. Spigset O. Anaesthetic agents and excretion in breast milk. Acta Anaesthesiol Scand 1994;38:94103.
    
    

Questions and Answers

When is Vecuronium used versus Pancuronium?,

Vecuronium is shorter acting, so it is used in shorter cases.

Pancuronium can cause tachycardia, so it's not used when heart rate is an issue, such as in people with certain heart valve problems or coronary artery disease. We also do not use it in those with renal dysfunction.

I won't use pancuronium on morbidly obese people, because I want to make sure there is no residual blockade, and panc can be harder to fully reverse.

The most common NMBA used where I work now is rocuronium - you don't have to mix it.

There is also the anesthesiologist's personal preferences to consider when it comes to NMBA use. Some of us like one drug, some like others.

will pancuronium cause the death of the patient if he/she is not intubated?,

Well, not if you bag the patient continuously, yourself. They would live as long as you bagged patient until the effect of the pancuronium wore off (i.e. if intubation was unsuccessful, etc.).

But if you do absolutely nothing and enough pancuronium is given...yes, the patient would die.

Pancuronium is a neuromuscular blocker...and would effectively block muscles necessary for respiration. The patient would stop breathing...and die within minutes, as the oxygen levels in the blood slowly dropped until hypoxic...and then so low as to not oxygenate the brain...and then death.

It would be quite terrifying for the patient, if they were conscious!
They would try to gasp for breath, but be unsuccessful...and then quickly get confused and then pass out...before dying.

So, hopefully the doctor administering the drug knows what they are doing...and can intubate the patient, or continue bagging if unable to intubate the patient...

why do you think this article on tennessee lethal injections is newsworthy?, NASHVILLE, Tenn. - A federal judge ruled Wednesday that Tennessee's new lethal injection procedures are cruel and unusual punishment, interrupting plans to execute a killer next week.

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The protocol "presents a substantial risk of unnecessary pain" and violates death row inmate Edward Jerome Harbison's constitutional protections under the Eighth Amendment, U.S. District Judge Aleta Trauger said.

The new protocol, released in April, does not ensure that inmates are properly anesthetized before the lethal injection is administered, Trauger said, which could "result in a terrifying, excruciating death."

A spokeswoman for the state attorney general's office said officials are reviewing the ruling and haven't decided whether to appeal. Gov. Phil Bredesen's office had no immediate comment.

Harbison was scheduled to be executed Sept. 26 for beating an elderly woman to death during a burglary in 1983.

Trauger did not issue a stay or throw out the death sentence for Harbison, who has lost all his appeals. He can be legally executed once the state adopts a valid method of execution, she said.

Another federal judge in Nashville this year ordered a delay in the execution of convicted killer Philip Workman, citing the likelihood that the state's new guidelines could still cause unconstitutional pain and suffering. But a three-judge panel of the 6th U.S. Circuit Court of Appeals lifted that temporary restraining order, and Workman was executed by lethal injection May 9.

Bredesen, a Democrat, in February placed a 90-day moratorium on executions because of several glaring problems with the state's execution guidelines, including conflicting instructions that mixed lethal injection instructions with those for the electric chair.

George Little, State Department of Correction commissioner, adopted the new protocol despite having knowledge about the remaining risks of excessive pain for inmates, Trauger said. A spokeswoman for Little did not immediately return a message seeking comment.

Little did not give enough consideration to a recommendation to discard the standard three-drug lethal injection cocktail in favor of a single drug method, Trauger said. Current training and medical expertise are not sufficient to ensure a painless execution, she said.

Most states use three drugs — thiopental, an anesthetic; pancuronium bromide, a nerve blocker and muscle paralyzer; and potassium chloride, a drug to stop the heart. Each is supposed to be capable of killing by itself, but if not, the anesthetic is supposed to render the inmate unconscious while the other drugs do the job.

Lethal injection has been adopted by 37 states as a cheaper and more humane alternative to electrocution, gas chambers and other execution methods. But at least 11 states suspended its use after opponents alleged it was ineffective and cruel.

The issue came to a head last year in California when a federal judge ordered that doctors assist in killing Michael Morales, who was convicted of raping and murdering a teenage girl. Doctors refused, and legal arguments continue.

The 8th U.S. Circuit Court of Appeals last month lifted a more than year-old stay on executions in Missouri, refusing to block capital punishment while a death-row inmate asked the U.S. Supreme Court to declare the state's form of lethal injection to be an unconstitutionally cruel punishment.

Tennessee executed convicted child killer Daryl Holton last week in its first electrocution since 1960.

Bredesen on Friday commuted a death sentence for Michael Joe Boyd because of "grossly inadequate" legal representation during post-conviction hearings. Boyd, who now goes by Mika'eel Abdullah Abdus-Samad, was convicted of murdering a man during an armed robbery in 1986. The death sentence was commuted to life without possibility of parole

The judge is correct.

Edit to get a life:

We have a death penalty not a "death by torture penalty."

Guys i was reading this one news article about death by injections and i dont really get all the full details?, can you please help me brifly summarize this

NASHVILLE, Tenn. - A federal judge ruled Wednesday that Tennessee's new lethal injection procedures are cruel and unusual punishment, interrupting plans to execute a killer next week.

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The protocol "presents a substantial risk of unnecessary pain" and violates death row inmate Edward Jerome Harbison's constitutional protections under the Eighth Amendment, U.S. District Judge Aleta Trauger said.

The new protocol, released in April, does not ensure that inmates are properly anesthetized before the lethal injection is administered, Trauger said, which could "result in a terrifying, excruciating death."

A spokeswoman for the state attorney general's office said officials are reviewing the ruling and haven't decided whether to appeal. Gov. Phil Bredesen's office had no immediate comment.

Harbison was scheduled to be executed Sept. 26 for beating an elderly woman to death during a burglary in 1983.

Trauger did not issue a stay or throw out the death sentence for Harbison, who has lost all his appeals. He can be legally executed once the state adopts a valid method of execution, she said.

Another federal judge in Nashville this year ordered a delay in the execution of convicted killer Philip Workman, citing the likelihood that the state's new guidelines could still cause unconstitutional pain and suffering. But a three-judge panel of the 6th U.S. Circuit Court of Appeals lifted that temporary restraining order, and Workman was executed by lethal injection May 9.

Bredesen, a Democrat, in February placed a 90-day moratorium on executions because of several glaring problems with the state's execution guidelines, including conflicting instructions that mixed lethal injection instructions with those for the electric chair.

George Little, State Department of Correction commissioner, adopted the new protocol despite having knowledge about the remaining risks of excessive pain for inmates, Trauger said. A spokeswoman for Little did not immediately return a message seeking comment.

Little did not give enough consideration to a recommendation to discard the standard three-drug lethal injection cocktail in favor of a single drug method, Trauger said. Current training and medical expertise are not sufficient to ensure a painless execution, she said.

Most states use three drugs — thiopental, an anesthetic; pancuronium bromide, a nerve blocker and muscle paralyzer; and potassium chloride, a drug to stop the heart. Each is supposed to be capable of killing by itself, but if not, the anesthetic is supposed to render the inmate unconscious while the other drugs do the job.

Lethal injection has been adopted by 37 states as a cheaper and more humane alternative to electrocution, gas chambers and other execution methods. But at least 11 states suspended its use after opponents alleged it was ineffective and cruel.

The issue came to a head last year in California when a federal judge ordered that doctors assist in killing Michael Morales, who was convicted of raping and murdering a teenage girl. Doctors refused, and legal arguments continue.

The 8th U.S. Circuit Court of Appeals last month lifted a more than year-old stay on executions in Missouri, refusing to block capital punishment while a death-row inmate asked the U.S. Supreme Court to declare the state's form of lethal injection to be an unconstitutionally cruel punishment.

Tennessee executed convicted child killer Daryl Holton last week in its first electrocution since 1960.

Bredesen on Friday commuted a death sentence for Michael Joe Boyd because of "grossly inadequate" legal representation during post-conviction hearings. Boyd, who now goes by Mika'eel Abdullah Abdus-Samad, was convicted of murdering a man during an armed robbery in 1986. The death sentence was commuted to life without possibility of parole

Basically they're going to put someone to death but they're not allowed to cause them any pain when they do so because hell, that's inhumane.

The combination of drugs makes a difference to the time it takes to die and what shuts down first.

can someone please help me understand this article on lethal injections in Tennessee?, DONT JUST GIVE ME AN OPINION BECAUSE THAT IS NOT HELPING

ok so i understand parts of what is going on here but i'm confused about whether it is the injections that are not allowed or if it is other methods that is not allowed. And also what is the new protocal they keep talking about and what is tennessee's current execution method????
can you please help me brifly summarize this

NASHVILLE, Tenn. - A federal judge ruled Wednesday that Tennessee's new lethal injection procedures are cruel and unusual punishment, interrupting plans to execute a killer next week.

ADVERTISEMENT


The protocol "presents a substantial risk of unnecessary pain" and violates death row inmate Edward Jerome Harbison's constitutional protections under the Eighth Amendment, U.S. District Judge Aleta Trauger said.

The new protocol, released in April, does not ensure that inmates are properly anesthetized before the lethal injection is administered, Trauger said, which could "result in a terrifying, excruciating death."

A spokeswoman for the state attorney general's office said officials are reviewing the ruling and haven't decided whether to appeal. Gov. Phil Bredesen's office had no immediate comment.

Harbison was scheduled to be executed Sept. 26 for beating an elderly woman to death during a burglary in 1983.

Trauger did not issue a stay or throw out the death sentence for Harbison, who has lost all his appeals. He can be legally executed once the state adopts a valid method of execution, she said.

Another federal judge in Nashville this year ordered a delay in the execution of convicted killer Philip Workman, citing the likelihood that the state's new guidelines could still cause unconstitutional pain and suffering. But a three-judge panel of the 6th U.S. Circuit Court of Appeals lifted that temporary restraining order, and Workman was executed by lethal injection May 9.

Bredesen, a Democrat, in February placed a 90-day moratorium on executions because of several glaring problems with the state's execution guidelines, including conflicting instructions that mixed lethal injection instructions with those for the electric chair.

George Little, State Department of Correction commissioner, adopted the new protocol despite having knowledge about the remaining risks of excessive pain for inmates, Trauger said. A spokeswoman for Little did not immediately return a message seeking comment.

Little did not give enough consideration to a recommendation to discard the standard three-drug lethal injection cocktail in favor of a single drug method, Trauger said. Current training and medical expertise are not sufficient to ensure a painless execution, she said.

Most states use three drugs — thiopental, an anesthetic; pancuronium bromide, a nerve blocker and muscle paralyzer; and potassium chloride, a drug to stop the heart. Each is supposed to be capable of killing by itself, but if not, the anesthetic is supposed to render the inmate unconscious while the other drugs do the job.

Lethal injection has been adopted by 37 states as a cheaper and more humane alternative to electrocution, gas chambers and other execution methods. But at least 11 states suspended its use after opponents alleged it was ineffective and cruel.

The issue came to a head last year in California when a federal judge ordered that doctors assist in killing Michael Morales, who was convicted of raping and murdering a teenage girl. Doctors refused, and legal arguments continue.

The 8th U.S. Circuit Court of Appeals last month lifted a more than year-old stay on executions in Missouri, refusing to block capital punishment while a death-row inmate asked the U.S. Supreme Court to declare the state's form of lethal injection to be an unconstitutionally cruel punishment.

Tennessee executed convicted child killer Daryl Holton last week in its first electrocution since 1960.

Bredesen on Friday commuted a death sentence for Michael Joe Boyd because of "grossly inadequate" legal representation during post-conviction hearings. Boyd, who now goes by Mika'eel Abdullah Abdus-Samad, was convicted of murdering a man during an armed robbery in 1986. The death sentence was commuted to life without possibility of parole

The new protocol is not giving the person drugs that will knock them out before the lethal drugs begin to kill the body. The inmate could feel physical and mental pain during the dying process because they would be awake and know what was going on and could feel the pain in the body as the drugs were taking effect, so they want to stop the injections until they feel it won't violate the inmates rights by causing him too much pain or anguish. Gas Chambers and Electric chairs cost alot and they don't want to use those so that is why they use injections mostly. Plus it has been considered an easier death since you are asleep and don't know what is happening. Most states have different options for what to use for an execution, and they usually give the inmate a choice.

Why aren't animals anesthesized?, I'm against meat-eating, but if you want to argue your 'right' to eat meat, why not at least do this? Convicted murderers on death row are anesthesized before lethal injection (sodium pentothal, followed by pancuronium bromide and potassium chloride). We are able to be humane to convicted killers, but not innocent animals?

because it costs too much money to waste that crap. whos gunna stop them from not using anesthesia? exaclty, stfu.

What would be Jakes words on the first interview comming back to the WWE and he crossbred an anacon/black mamb, anaconda/black mamba. I got one: "you know what they say, the older the wiser. After creating pancuronium I figured...why beat your opponent when you could have your snake EAT your opponent hehehe". :-P

does it matter

Which of the following NBM needs reconstitution?, Pancuronium
Atracurium
Vecuronium
Rocuronium

vecuronium- it's the only one that comes in powdered form. the others are all in solutions.

what is the most recent treatment of cerebral odema caused by head injury.a boy needs to be saved.?, unconcious since 5 days . rt pupil reacting but small, not pin point
left pupil dilated not reacting.
patient on ventilator with pancuronium.
all drugs in adequate doses given to reduce oedema
fever 99.5fht

I assume he is hospitalized at this time. His treating physician should be and I hope is a neurosurgeon. Another CT scan needs to be done to see if there is a bleed anywhere. If so, this is putting pressure and will need to be released. I would say that the doctor will take this boy to surgery to either place an interior or exterior shunt so that the fluid can be drained to relieve the pressure. Good luck and if your doctor is not doing his job, get another so this life can be saved/.