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Updated: Sep 11, 2026

Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 18, 2011
[Rocuronium or vecuronium for intubation for short operations in the preschool age? Effects on time in the operating
1Institut für Anästhesiologie und Intensivmedizin, Leopoldina-Krankenhauses der Stadt Schweinfurt gGmbH. gunther.pestel@cc-online.de
Insights
Rocuronium and vecuronium are effective neuromuscular blockers for pediatric surgery. Rocuronium demonstrated faster recovery, making it a potentially better choice for intubation in young children.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Neuromuscular blocking agents are essential in pediatric anesthesia.
- Rocuronium and vecuronium are commonly used non-depolarizing muscle relaxants.
- Understanding their comparative effects in infants is crucial for optimizing postoperative care.
Purpose of the Study:
- To compare the effects of rocuronium and vecuronium on the early postoperative period in infants undergoing elective ENT procedures.
- To evaluate intubation time, extubation to operating theatre departure interval, and recovery of neuromuscular function.
Main Methods:
- Prospective randomized study of 48 infants (3-6 years old).
- Anesthesia induced with thiopentone and halothane.
- Administered rocuronium (0.4 mg/kg) or vecuronium (0.075 mg/kg).
- Independent anesthetists unaware of drug used; monitoring via pulse oximetry and TOF-ratios.
Main Results:
- No significant differences in intubation time or extubation to theatre departure time.
- No differences in oxygen saturation (SaO2) during recovery.
- Rocuronium showed significantly higher TOF-ratios at extubation and arrival in recovery, indicating faster neuromuscular recovery.
Conclusions:
- Both rocuronium and vecuronium are suitable for intubation in short pediatric operations.
- Rocuronium offers superior and faster neuromuscular recovery compared to vecuronium in this pediatric population.
- Rocuronium may be the preferred agent for pediatric anesthesia due to its advantageous recovery profile.
Abstract:
This prospective randomized study compares the effects of rocuronium (R) and vecuronium (V) on the early postoperative period in infants. Forty-eight infants between the ages of three and six, scheduled for elective ENT procedures, were studied after prior approval of local ethics committee and informed parental consent. All children were premedicated with chlorprotixene and belladonna. Anaesthesia was induced with 5 mg/kg thiopentone and 1 vol.-% halothane. Subsequently, 0.4 mg/kg rocuronium or 0.075 mg/kg vecuronium were administered, respectively. Anaesthesia and post-operative care were conducted by independent anaesthetists, who were unaware of the drug used and of the relaxometric data obtained. All children were monitored in the recovery room by pulse oximetry until they reached a Steward Score of 6. Demographic data did not differ between the groups. No differences were recorded between the non-depolarizing relaxants regarding intubation time (R: 24.1 +/- 4.2 min, V: 25.8 +/- 6.8 min) and the time interval from end extubation to leaving the operating theatre (R: 2.3 +/- 0.8 min, V: 2.6 +/- 1.2 min), respectively. Similarly, no differences in SaO2 were noted during the recovery period in the recovery room. Significant differences between the non-depolarizing relaxants were found in the TOF-ratios at extubation (R: 0.73 +/- 0.31 min, V: 0.48 +/- 0.34 min) and arrival in the recovery room (R: 0.88 +/- 0.21 min, V: 0.69 +/- 0.26 min). 0.4 mg/kg Rocuronium and 0.075 mg/kg vecuronium can be used for intubation during short operations on pre-school children. Rocuronium may be the better alternative, due to its faster neuromuscular recovery properties.
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