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Effects of priming with pancuronium or rocuronium on intubation with rocuronium in children
1Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea.
Insights
Priming doses of pancuronium or rocuronium did not improve neuromuscular blockade for intubation in children. Rocuronium alone showed faster recovery times compared to pancuronium priming.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Rocuronium is a non-depolarizing neuromuscular blocking agent with rapid onset and intermediate duration.
- Pediatric anesthesia often requires precise control of neuromuscular blockade.
Purpose of the Study:
- To compare the neuromuscular blocking effects of rocuronium with and without priming doses of pancuronium or rocuronium in pediatric patients.
- To evaluate the impact of priming on intubation conditions and recovery.
Main Methods:
- Thirty pediatric patients were randomized into three groups.
- Group I received a single dose of rocuronium.
- Groups II and III received priming doses of pancuronium or rocuronium, respectively, followed by rocuronium for intubation.
- Neuromuscular blockade was assessed using accelerography and train-of-four (TOF) stimulation.
Main Results:
- Onset time and duration of neuromuscular blockade were similar across all groups.
- Recovery time was significantly prolonged in the pancuronium priming group (Group II) compared to the rocuronium-only (Group I) and rocuronium priming (Group III) groups.
- No significant difference in recovery time was observed between Group I and Group III.
Conclusions:
- Priming with pancuronium or rocuronium does not offer an advantage for tracheal intubation in children.
- Pancuronium priming significantly prolongs recovery time compared to rocuronium alone or rocuronium priming.
- Rocuronium alone or with a rocuronium prime provides comparable and efficient neuromuscular blockade for pediatric intubation.
Abstract:
Rocuronium is a non-depolarizing neuromuscular blocking agent which has a rapid onset and intermediate duration of action. The goal of this study was to compare the neuromuscular blocking actions of rocuronium with and without a priming dose of pancuronium or rocuronium in children. Thirty patients were randomly allocated into 3 groups. Ten patients received a single dose of 0.6 mg/kg rocuronium (Group I). The others received either 0.015 mg/kg pancuronium (Group II) or 0.06 mg/kg rocuronium (Group III) 3 minutes before an intubating dose of 0.54 mg/kg rocuronium was given. Neuromuscular blockade was measured via accelerographic response to single stimulations (1 Hz) of the ulnar nerve until maximal twitch depression was reached followed by train-of-four (TOF) stimuli (2 Hz) at 15 second intervals for the remainder of recovery. Groups were compared with regard to onset time, duration and recovery indices. The onset time and duration of block did not differ significantly between groups. However, the time to recovery in group II (24.5 +/- 9.9 min) was significantly prolonged compared to that in group I (12.7 +/- 3.1 min) or group III (12.7 +/- 3.9 min). We concluded that the use of rocuronium with a preceding dose of either pancuronium or rocuronium provided no advantage for intubation in children.