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Dose requirements of atracurium in paediatric intensive care patients
O T Kushimo1, M J Darowski, P Morris
1Royal Manchester Children's Hospital, Pendlebury.
Insights
Pediatric intensive care patients receiving mechanical ventilation showed increasing atracurium infusion needs over time. Higher atracurium doses were required in children compared to adults, with prompt reversal upon discontinuation and no observed side effects.
Area of Science:
- Pharmacology
- Pediatric Critical Care
- Anesthesiology
Background:
- Neuromuscular blocking agents are crucial for mechanical ventilation in intensive care.
- Atracurium is a commonly used non-depolarizing neuromuscular blocker.
- Understanding pediatric dose requirements is essential for safe and effective use.
Purpose of the Study:
- To determine the dose requirements of atracurium in pediatric patients requiring mechanical ventilation.
- To assess the infusion rates and duration of neuromuscular block.
- To evaluate the safety profile of atracurium infusion in children.
Main Methods:
- Observational study involving 12 pediatric patients in the intensive care unit.
- Continuous infusion of atracurium to facilitate mechanical ventilation.
- Monitoring of infusion rates and duration.
- Assessment of neuromuscular block reversal upon discontinuation.
Main Results:
- The mean duration of atracurium infusion was 98 hours.
- All patients demonstrated an increasing dose requirement over the infusion period.
- Mean infusion rates were 1.60 mg kg-1 h-1, with higher rates observed at 72 hours (1.72 mg kg-1 h-1).
- Pediatric infusion rates exceeded those previously reported in adults.
- Neuromuscular block reversal was prompt after discontinuing the infusion.
- No adverse side effects were attributed to atracurium infusion.
Conclusions:
- Pediatric patients require higher atracurium infusion rates than adults for mechanical ventilation.
- Dose requirements increase over prolonged infusions in children.
- Atracurium is effective and safe for prolonged neuromuscular blockade in pediatric intensive care.
Abstract:
The dose requirements of atracurium were determined in 12 children who required an infusion of atracurium to facilitate mechanical ventilation in the intensive care unit. The mean duration of infusion was 98 h (range 36-284 h) during which an increasing dose requirement was observed in all patients. The mean infusion rate was 1.60 (SEM 0.08) mg kg-1 h-1, and in seven patients a mean infusion rate of 1.72 (0.15) mg kg-1 h-1 was observed at 72 h. These rates are greater than those reported previously in adults. Cessation of neuromuscular block occurred promptly upon discontinuing the infusion. No side effects were observed which could be attributed to the infusion of atracurium.