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Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children
M Eikermann1, I Hunkemöller, L Peine
1Abteilung für Anästhesiologie und Intensivmedizin, Universität Essen, Hufelandstr. 55, D-45122 Essen, Germany.
Insights
Rocuronium at 0.29 mg/kg optimizes intubation conditions for children during sevoflurane inhalation induction. This dose provides a 95% probability of acceptable intubation, crucial for pediatric anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Neuromuscular Blockade
Background:
- Inhalation induction with sevoflurane is common in pediatric anesthesia.
- Optimizing neuromuscular blockade is essential for successful intubation.
- Rocuronium's optimal dose for intubation during sevoflurane induction in children requires definition.
Purpose of the Study:
- To determine the rocuronium dose providing a 95% probability of acceptable intubation conditions (ED95TI).
- To evaluate rocuronium's efficacy during inhalation induction with sevoflurane in children aged 2-7 years.
Main Methods:
- Prospective, randomized, assessor-blinded study of 120 children.
- Inhalation induction with sevoflurane followed by varying rocuronium doses or placebo.
- Neuromuscular function assessed via accelerometry; intubation conditions evaluated 2 minutes post-injection.
Main Results:
- Rocuronium doses of 0.24 mg/kg and 0.29 mg/kg provided 90% and 95% probability of acceptable intubation, respectively.
- Acceptable intubation conditions were achieved in 97% of children when thumb acceleration decreased by ≥50%.
- Recovery of neuromuscular function (train-of-four ratio to 0.8) varied by dose, averaging 12-50 minutes.
Conclusions:
- Rocuronium 0.29 mg/kg is the optimal dose (ED95) for intubation during sevoflurane inhalation induction in children.
- This dose ensures optimal intubating conditions for short-duration pediatric surgical procedures.
- The study provides critical data for safe and effective pediatric anesthesia.
Background:
We studied 120 children aged 2-7 yr in a prospective, randomized, assessor-blinded fashion to define the optimal rocuronium dose which provides a 95% probability of acceptable intubation conditions (ED95TI) during inhalation induction with sevoflurane.
Methods:
After inhalation induction with 8% sevoflurane in 60% nitrous oxide and 40% oxygen, and loss of the eyelash reflex, we administered rocuronium (0.1, 0.15, 0.22, 0.3, or 0.6 mg kg-1) or placebo. We quantified neuromuscular function by stimulation of the ulnar nerve at 0.1 Hz to produce contraction of the adductor pollicis muscle using accelerometry. Intubation conditions were assessed 2 min after test drug injection. The optimal rocuronium dose was defined as the lowest dose, which allowed acceptable intubation conditions in 95% of children (ED95TI).
Results:
Two minutes after injection of placebo or rocuronium, intubation conditions were acceptable in 35, 45, 80, 90, 95, and 100% of children, respectively. Rocuronium 0.07 [CI 0.02-0.11], 0.24 [0.19-0.31], and 0.29 [0.23-0.38] mg kg-1 provided 50, 90, and 95% probability of acceptable intubating conditions. When thumb acceleration was depressed by 50% or more, intubating conditions were considered acceptable in 97% of children. Recovery of the train-of-four ratio to 0.8 averaged 12 (7), 16 (7), 24 (7), 24 (8), and 50 (22) min after the respective dose of rocuronium.
Conclusions:
During inhalation induction with 8% sevoflurane in 60% nitrous oxide, rocuronium 0.29 mg kg-1 (ED95) optimizes intubation conditions for surgery of short duration.