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A dose-ranging study of rapacuronium in pediatric patients
G H Meakin1, O A Meretoja, J Motsch
1Department of Anesthesia, the University of Manchester, United Kingdom. george.meakin@man.ac.uk
Insights
This study found that 1.5 mg/kg rapacuronium in infants and 2.0 mg/kg in children provide good tracheal intubation conditions within 60 seconds. Rapacuronium offers a short duration of action for pediatric anesthesia.
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
- Clinical Trials
Background:
- Evaluating new anesthetic agents is crucial for pediatric patient care.
- Rapacuronium is a novel rapid-onset, short-acting neuromuscular blocking drug.
- Determining optimal dosing for tracheal intubation in pediatric populations is essential.
Purpose of the Study:
- To establish the effective dose of rapacuronium for rapid tracheal intubation in infants and children.
- To assess the safety and efficacy of rapacuronium in diverse pediatric age groups.
Main Methods:
- A dose-ranging study involving 165 infants and children (under 12 years).
- Administration of five different doses of rapacuronium (0.5-2.5 mg/kg) post-induction.
- Assessment of intubating conditions using a standardized scale and monitoring neuromuscular transmission.
Main Results:
- Satisfactory intubation conditions achieved at 60s with ≥1.5 mg/kg in infants and ≥2.0 mg/kg in children.
- Rapacuronium's duration of action was dose- and age-dependent, generally short.
- Adverse events were infrequent and mild, including bronchospasm and tachycardia.
Conclusions:
- Doses of 1.5 mg/kg (infants) and 2.0 mg/kg (children) of rapacuronium provide effective tracheal intubation.
- Rapacuronium demonstrates a favorable short duration of action for pediatric anesthesia.
- The drug is associated with a low incidence of minor adverse events.
Background:
The aim of this study was to determine the dose or doses of the new rapid-onset, short-acting, neuromuscular blocking drug rapacuronium that would provide satisfactory conditions for tracheal intubation at 60 s in infants and children.
Methods:
Sixty-five infants (< 1 yr), 51 younger children (1-6 yr), and 49 older children (7-12 yr) were studied. Anesthesia was induced with thiopental-nitrous oxide-oxygen. Tracheal intubation was attempted 60 s after administration of one of five doses of rapacuronium (0.5, 1.0, 1.5, 2.0, or 2.5 mg/kg) and intubating conditions were assessed using a four-point scale. Following tracheal intubation, anesthesia was maintained with nitrous oxide-oxygen and alfentanil (12.5-50 microg/kg) as necessary. Neuromuscular transmission was monitored in an uncalibrated fashion using an acceleromyograph.
Results:
Intubating conditions were good or excellent at 60 s in all infants after doses of 1.5 mg/kg or more and in all younger and older children after doses of 2.0 mg/kg or more. The duration of action of rapacuronium was dose- and age-dependent. Mean times to reappearance of the third twitch of the train-of-four (TOF; T3) were less than 10 min in infants at doses of 1.5 mg/kg or less and in younger and older children at doses of 2.0 mg/kg or less. Recovery of T3 after 1.0-2.0 mg/kg rapacuronium was significantly slower in infants compared with younger (P = 0.001) and older (P = 0.02) children. Five adverse experiences were related to rapacuronium administration: Bronchospasm (two instances), tachycardia (one instance), and increased salivation (two instances). None were serious.
Conclusions:
Doses of 1.5 and 2.0 mg/kg rapacuronium can produce satisfactory intubating conditions at 60 s in anesthetized infants and children, respectively, and are associated with a short duration of action.