Tubocurarine and the neonate

Tubocurarine, given as a single bolus, may be used safely for neuromuscular blockade in the neonate. The recommended dose is 250 mug/kg at birth, increasing to 500 mug/kg at 28 days of age. This dose should be reduced in the event of prematurity, acidosis or hypothermia, or when certain antibiotics or inhalation anaesthetic agents are present in the tissues. A single dose as described has a duration of approximately 1 h and it is only after this time that satisfactory antagonism can be obtained. The potency of pancuronium when compared with tubocurarine in the study is 6:1, from birth to 28 days.