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The effect on lung mechanics in anesthetized children with rapacuronium: a comparative study with mivacurium
Gavin F Fine1, Etsuro K Motoyama, Barbara W Brandom
1Department of Anesthesiology, Division of Pulmonology, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA. finegf@anes.upmc.edu
Anesthesia and Analgesia
|June 29, 2002
Summary
Rapacuronium causes severe, reversible bronchoconstriction in children, unlike mivacurium which causes only mild effects. This study confirms clinical reports of rapacuronium-induced bronchospasm using pulmonary function tests.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
Background:
- Rapacuronium is associated with severe bronchospasm, but direct pulmonary function studies in children are lacking.
- Understanding the airway effects of neuromuscular blocking agents is crucial for pediatric anesthesia.
Purpose of the Study:
- To compare the effects of rapacuronium and mivacurium on pulmonary function in young children.
- To investigate the incidence and severity of airway constriction induced by rapacuronium.
Main Methods:
- Ten pediatric patients (2-6 years) received either rapacuronium or mivacurium.
- Pulmonary function tests were conducted at baseline, post-muscle relaxant, and post-beta2 agonist administration.
- Anesthesia involved sevoflurane, remifentanil, and propofol infusions.
Main Results:
- Rapacuronium significantly decreased maximal expiratory flow rates (MEF(10) and MEF(FRC)), indicating severe bronchoconstriction.
- Mivacurium caused only mild, subclinical decreases in MEF(10) and no significant change in MEF(FRC).
- Static respiratory compliance remained unchanged in both groups; all effects were reversible with albuterol.
Conclusions:
- Rapacuronium consistently causes severe, reversible bronchoconstriction in pediatric patients.
- Mivacurium induces minimal, subclinical bronchoconstriction.
- Findings support clinical observations of rapacuronium-induced bronchospasm.