Continuous vecuronium infusion for prolonged muscle relaxation in children

Area of Science:

• Anesthesiology
• Pediatric Critical Care
• Pharmacology

Background:

• Mechanical ventilation is crucial for respiratory support in critically ill pediatric patients.
• Neuromuscular blocking agents are often used to facilitate mechanical ventilation.
• Vecuronium is a commonly used non-depolarizing neuromuscular blocker.

Purpose of the Study:

• To evaluate the efficacy and safety of continuous vecuronium infusion for facilitating mechanical ventilation in pediatric intensive care.
• To determine appropriate dosing and infusion rates for vecuronium in neonates, infants, and children.

Main Methods:

• A loading dose of vecuronium (0.1 mg/kg) followed by a continuous infusion was administered.
• Infusion rates were adjusted to maintain approximately 90% neuromuscular blockade, monitored by train-of-four stimulation.
• Study included 11 infants/children and 4 neonates, with infusion durations ranging from 9.5 to 179 hours.

Main Results:

• Mean vecuronium infusion doses were 0.14 mg/kg/hr in children and 0.11 mg/kg/hr in neonates.
• Mean recovery times after stopping infusion were 51.7 minutes (children) and 46.8 minutes (neonates).
• No adverse cardiovascular or toxic effects were observed during the study.

Conclusions:

• Continuous vecuronium infusion is a feasible and satisfactory method for facilitating mechanical ventilation in pediatric intensive care.
• The technique allows for sustained neuromuscular blockade with predictable recovery times.
• Vecuronium infusion appears safe for use in neonates, infants, and children requiring prolonged mechanical ventilation.