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Randomised controlled trial comparing cisatracurium and vecuronium infusions in a paediatric intensive care unit
Margarita Burmester1, Quen Mok
1Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA. Margarita.Burmester@CARDIO.CHBOSTON.ORG
Insights
Cisatracurium offers faster recovery of neuromuscular function in critically ill children on mechanical ventilation compared to vecuronium. Neuromuscular monitoring may not prevent prolonged recovery with vecuronium infusions.
Area of Science:
- Critical Care Medicine
- Pediatric Pharmacology
- Neuromuscular Blockade
Background:
- Critically ill children on mechanical ventilation often require neuromuscular blocking drugs.
- Vecuronium and cisatracurium are commonly used agents, but their comparative recovery profiles in pediatric populations are not fully elucidated.
Purpose of the Study:
- To compare the efficacy, infusion rates, and recovery characteristics of continuous vecuronium versus cisatracurium infusions in pediatric intensive care unit patients.
- To assess the incidence of prolonged neuromuscular recovery in these patients.
Main Methods:
- A prospective, randomized, double-blind, single-center study involving 37 critically ill children (3 months to 16 years).
- Patients received either vecuronium or cisatracurium infusions, with neuromuscular blockade monitored using Train-of-Four (TOF) Watch.
- Recovery time was defined as the interval from infusion cessation to a TOF ratio of 70%.
Main Results:
- The median recovery time was significantly shorter with cisatracurium (52 minutes) compared to vecuronium (123 minutes).
- One child (6%) receiving vecuronium experienced prolonged neuromuscular recovery exceeding 24 hours.
- Infusion rates and durations varied between the two drug groups.
Conclusions:
- Cisatracurium facilitates a significantly faster recovery of neuromuscular function post-infusion in pediatric critical care patients compared to vecuronium.
- Current neuromuscular monitoring strategies may be insufficient to prevent prolonged recovery in children receiving vecuronium infusions.
Objective:
To evaluate and compare the efficacy, infusion rate and recovery profile of vecuronium and cisatracurium continuous infusion in critically ill children requiring mechanical ventilation.
Design And Setting:
Prospective, randomised, double-blind, single-centre study in critically ill children in a paediatric intensive care unit in a tertiary children's hospital.
Methods:
Thirty-seven children from 3 months to 16 years old (median 4.1 year) were randomised to receive either drug; those already receiving more than 6 h of neuromuscular blocking drugs were excluded. The Train-of-Four (TOF) Watch maintained neuromuscular blockade to at least one twitch in the TOF response. Recovery time was measured from cessation of infusion until spontaneous TOF ratio recovery of 70%.
Results:
The cisatracurium infusion rate in nineteen children averaged 3.9+/-1.3 microg kg(-1) min(-1) with a median duration of 63 h (IQR 23-88). The vecuronium infusion rate in 18 children averaged mean 2.6+/-1.3 microg kg(-1) min(-1) with a median duration of 40 h (IQR 27-72). Median time to recovery was significantly shorter with cisatracurium (52 min, 35-73) than with vecuronium (123 min, 80-480). Prolonged recovery of neuromuscular function (>24 h) occurred in one child (6%) on vecuronium.
Conclusions:
Recovery of neuromuscular function after discontinuation of neuromuscular blocking drug infusion in children is significantly faster with cisatracurium than vecuronium. Neuromuscular monitoring was not sufficient to eliminate prolonged recovery in children on vecuronium infusions.
