[Severely burned patients and atracurium: the train-of-four response]

Severely burned patients show a relative hyposensitivity to atracurium. The neuromuscular block obtained in 20 patients with major thermal injury after 0.75 mg.kg-1 i.v. of atracurium, by muscular activity recording (train of four-TOF), was studied. The results confirmed the resistance to atracurium, which mechanism is unknown. Even the doses administered, 50% higher than clinical dose (0.3-0.5 mg.kg-1), proved insufficient in order to obtain a complete neuromuscular block in severely burned patients.