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Resistance to vecuronium in burned children
1Department of Anaesthesiology, Ege University Hospital, Izmir, Turkey.
Insights
Burned children exhibit a slower onset of action for vecuronium, a neuromuscular blocking agent. Recovery from vecuronium is significantly faster in burned children, indicating decreased sensitivity.
Area of Science:
- Anesthesiology
- Pharmacology
- Pediatric Surgery
Background:
- Neuromuscular blocking agents like vecuronium are crucial in surgical anesthesia.
- Burn injuries can alter drug pharmacokinetics and pharmacodynamics.
- Understanding vecuronium's action in burned pediatric patients is vital for safe anesthesia.
Purpose of the Study:
- To compare the time-course of action of vecuronium in burned versus unburned children.
- To assess vecuronium's onset and recovery characteristics in pediatric patients undergoing surgery.
Main Methods:
- A comparative study involving 16 burned and 10 unburned children.
- Administration of vecuronium 0.1 mg/kg intravenously.
- Monitoring neuromuscular responses using acceleromyography and train-of-four (TOF) stimuli.
- Recording onset time and various recovery parameters (T1, TOF).
Main Results:
- Onset of vecuronium action was significantly slower in burned children (189 ± 70 s) compared to controls (98 ± 20 s).
- Recovery times (T1-25%, T1-50%, T1-75%, TOF-25%, TOF-50%) were significantly shorter in burned children.
- Shorter recovery times suggest decreased sensitivity to vecuronium in burned pediatric patients.
Conclusions:
- Burned children demonstrate a delayed onset of neuromuscular blockade with vecuronium.
- Burned children exhibit accelerated recovery from vecuronium, implying reduced sensitivity.
- Anesthetic management may require adjustments in vecuronium dosage or timing for burned pediatric patients.
Abstract:
We compared the time-course of action of vecuronium in 16 burned children undergoing excision and autograft surgery with that of ten unburned children. Standardized anaesthesia was induced with thiopentone 4-6 mg kg-1 and fentanyl 1 microgram.kg-1 and maintained with endtidal 1-1.5% isoflurane in N2O/O2. Neuromuscular responses were monitored by acceleromyography (TOF-Guard, Organon Teknika/Biometer) with supramaximal train-of-four (TOF) stimuli delivered every 15s. Vecuronium 0.1 mg kg-1 was administered intravenously. Onset was recorded as the time, in seconds, between the initial bolus of vecuronium and a decline in the first twitch of TOF (T1) to 5% of control. The times for the recovery of T1-25%, 50% and 75% of control, recovery index and the recovery of TOF 25% and 50% were recorded. Onset of action was found slower in burned patients (189 +/- 70 s) than in control (98 +/- 20 s) (P < 0.01). Recovery times of T1(25), T1(50), T1(75), TOF25 and TOF50 were significantly shorter in burned patients indicative of decreased sensitivity to vecuronium (P < 0.01).