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Undernutrition in children--effect on vecuronium induced neuromuscular blockade
1Dept of Anesthesiology and Critical Care, University College of Medical Sciences, Delhi, India.
Insights
Malnutrition significantly impacts how children
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Nutritional Science
Background:
- Nutritional status is crucial for pediatric patients undergoing anesthesia.
- Muscle relaxants like vecuronium bromide are commonly used in pediatric anesthesia.
- The impact of malnutrition on neuromuscular blockade in children requires further investigation.
Purpose of the Study:
- To assess the effect of varying nutritional status on the neuromuscular effects of vecuronium bromide in children.
- To determine if malnutrition alters the onset, duration, and reversal of vecuronium-induced neuromuscular blockade.
Main Methods:
- Sixty children (1-12 years) were categorized into four nutritional groups (normal, mild, moderate, severe).
- Vecuronium bromide (0.1 mg/kg) was administered, and neuromuscular effects were monitored using train-of-four (TOF) nerve stimulation and accelerometry.
- Onset time, maximal depression, and duration of action were recorded.
Main Results:
- A statistically significant delay in the onset of neuromuscular blockade was observed in malnourished children.
- The duration of action for both initial and top-up doses of vecuronium was significantly shortened in undernourished groups.
- Reversal time with neostigmine was not significantly affected by nutritional status.
Conclusions:
- Malnutrition significantly alters the pharmacodynamics of vecuronium bromide in pediatric patients.
- Dosage adjustments for vecuronium may be necessary in malnourished children to achieve desired clinical effects.
- Further research into anesthetic drug metabolism and response in malnourished pediatric populations is warranted.
Abstract:
Sixty children aged one to 12 years requiring anaesthesia including a muscle relaxant were assessed for their nutritional status based on simple anthropometric and biochemical parameters. They were allocated to one of four groups: normal nutrition, mild, moderate or severe malnutrition. The neuromuscular effects of vecuronium bromide 0.1 mg/kg were studied by recording evoked responses to train of four (TOF) nerve stimulation using an accelerograph. In the above nutritional groups, time to onset of 25% depression of T1 was 0.8, 1.4, 1.3 and 2.1 minutes respectively. Maximal depression of TOF response was seen at 2.2, 3.2, 3.7 and 8.4 minutes. The duration of action of the initial dose was 26.5, 24.0, 17.7 and 13.3 minutes and the mean duration of action of top-up doses was 16.2, 14.9, 11.2 and 8.9 minutes respectively. Reversal time with neostigmine 0.05 mg/kg was not significantly different in the four groups. These results demonstrate a statistically significant delay in onset and shortening of the duration of action of vecuronium in the undernourished groups compared with the normal nutrition group when vecuronium is administered to children on a milligram per kilogram basis.