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Reduced-dose rocuronium for day-case tonsillectomy in children where volatile anaesthetics are not used: operating

Dubravka Bartolek1, Jasminka Jakobović, Franjo Bartolek

  • 1Department of Anaesthesiology and Intensive Care Medicine, University Clinic of Traumatology, Kuhaceva, Zagreb, Croatia. dubravka.bartolek1@zg.t-com.hr

Paediatric Anaesthesia
|October 30, 2009
PubMed
Abstract

Insights

Reduced-dose rocuronium in pediatric anesthesia significantly shortens operating room time and speeds patient recovery. This approach offers a safe and effective alternative for short surgical procedures, improving surgical workflow and patient outcomes.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Neuromuscular blocking agents (NMB) like mivacurium, rocuronium, and vecuronium are vital in pediatric anesthesia.
  • Mivacurium is ideal for short procedures but lacks global availability.
  • Optimizing NMB use is crucial for efficient day-case surgeries in children.

Purpose of the Study:

  • To evaluate the operating room time reduction using a reduced dose of rocuronium (0.45 mg/kg).
  • To assess the impact of reduced-dose rocuronium on intubating conditions and patient recovery.
  • To compare the efficacy of reduced-dose rocuronium with standard doses and vecuronium in pediatric tonsillectomy.

Main Methods:

  • A prospective, double-blind study involving 105 children (6-9 years, ASA I/II) undergoing day-case tonsillectomy.
  • Random assignment into three groups receiving vecuronium (0.1 mg/kg), standard rocuronium (0.6 mg/kg), or reduced-dose rocuronium (0.45 mg/kg).
  • Anesthesia maintained with propofol and alfentanil; neuromuscular transmission monitored via acceleromyography.

Main Results:

  • Reduced-dose rocuronium significantly shortened the time to neuromuscular block recovery (7.3 min vs. 15.9-16.0 min).
  • Onset time was prolonged with reduced-dose rocuronium (3.1 min vs. 1.3-2.2 min) but maintained acceptable intubating conditions.
  • Maximum operating room time savings of 37% were achieved with reduced-dose rocuronium, alongside low incidences of postoperative nausea/vomiting (3-6%) and good pain scores.

Conclusions:

  • Reduced-dose rocuronium, combined with propofol and alfentanil, effectively saves operating room time in pediatric day-case surgery.
  • This approach accelerates patient recovery, ensures acceptable intubating conditions, and optimizes surgical work.
  • Low rates of postoperative nausea, vomiting, and pain are achievable with this anesthetic regimen.

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