UNTOWARD REACTIONS TO CURARE CONSEQUENT TO VAGAL HYPERACTIVITY FOLLOWING ELECTROSHOCK CONVULSIONS

Abstract

AT TIMES it is necessary to diminish the violence of convulsions induced in the treatment of mental diseases; this has led in some instances to the practice of premedication with curare, in the form of "intocostrin." While this procedure has been employed successfully many times, its use creates certain hazards not ordinarily associated with convulsant therapy. The commonly recognized untoward manifestation associated with curarization is respiratory paralysis. This appears to be of two types, consequent either (a) to severe generalized muscular weakness, which may be overcome rapidly with neostigmine methylsulfate, or (b) to central depression of respiration, as noted by Fegler.¹ The latter type may be associated with no unusual weakness of skeletal muscle² and is not noticeably benefited by neostigmine.³ These reactions, though hazardous, are amenable to rational therapy and become dangerous largely through lack of preparedness for their occurrence. Still another type of accident has,