Ineffective Norcuron

["David Ellis" <davidcfp@hotmail.com>]

Has anyone had an instance in which Norcuron has failed to induce paralysis 
in a patient?  Case in point:  young female seen in small ED for status 
seizures.  10mg ativan and 40mg valium given with no affect on seizure 
activity.  Pt was intubated and evenually stopped seizing prior to flight 
crew's arrival. Pt was found by flight crew to be very combative with ED 
staff pushing large amounts of valium and versed in an attempt to control 
the patient, who required four staff members to hold her down.  As this 
small ER did not stock any form of paralytic, the flight crew pushed 10mg 
Norcuron with no affect on the patient.  The IV lines were patent and the 
norcuron was in date and recently purchased.  Further versed was given and 
the patient restrained, at which time the patient momentarily lapsed into 
unconsciousness, but would still withdraw from pain.  Pt was taken to 
aircraft and shortly after take off became combative again.  An additional 
10 mg dose of Norcuron was given, inducing paralysis for less than 10 
minutes.  Prior to transport and throughout the 75 minute flight, numerous 
forms of sedation were attempted, with no evident affect to the patient.  
The crew spent the majority of the flight physically restraining the 
patient.  If anyone has had a similar experience, or can shed some light on 
the causes for this, I would greatly appreciate it!
David



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