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Combination of nitrous oxide and lidocaine to prevent withdrawal after rocuronium in children
Hyun-Jeong Kwak1, Yun Jeong Chae, Sook Young Lee
1Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea.
Insights
Pretreating pediatric patients with nitrous oxide and lidocaine significantly reduces painful withdrawal responses to rocuronium injection. This combination therapy offers a safer anesthesia experience for children undergoing procedures.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Pharmacology
Background:
- Pain on injection is a frequent adverse event associated with rocuronium administration in pediatric patients.
- Effective pain management strategies are crucial for improving pediatric patient comfort during anesthesia induction.
Purpose of the Study:
- To evaluate the efficacy of combined nitrous oxide and lidocaine pretreatment in mitigating withdrawal responses to rocuronium injection in children.
- To compare the incidence of withdrawal movements between a nitrous oxide/lidocaine group and an oxygen/lidocaine group.
Main Methods:
- A prospective, randomized, double-blind study involving 66 pediatric patients (ages 5-12 years).
- Patients received either 100% oxygen or 50% nitrous oxide in oxygen.
- Anesthesia was induced with thiopental, followed by forearm occlusion, lidocaine injection, and subsequent rocuronium injection, with responses graded on a 4-point scale.
Main Results:
- The incidence of withdrawal movements was significantly lower in the nitrous oxide group (3.1%) compared to the oxygen group (25.8%) (P = 0.013).
- No patients in the nitrous oxide group exhibited severe withdrawal movements (grade 3 or 4).
Conclusions:
- Inhaled 50% nitrous oxide combined with lidocaine pretreatment effectively reduces rocuronium-induced withdrawal movements in pediatric patients.
- This combination therapy represents a significant improvement over lidocaine pretreatment alone for managing injection pain in children.
Background:
Pain at the site of rocuronium injection is a common side-effect in pediatric patients. This prospective, randomized, double-blind study evaluated the efficacy of a combination of nitrous oxide and lidocaine pretreatment on withdrawal response during rocuronium injection in children.
Methods:
Sixty six pediatric patients, ages 5 to 12 years, were randomly assigned to two groups. The oxygen group received 100% oxygen, and the nitrous oxide group received 50% N(2)O in oxygen over 2 min. After anesthesia was induced with 2.5% thiopental sodium 5 mg/kg and manual occlusion of the forearm was performed, 1% lidocaine 1 mg/kg was injected over 15 sec. After the occlusion was released, 0.1% rocuronium 0.6 mg/kg was injected over 5 sec. Patient response to rocuronium injection was graded using a 4-point scale.
Results:
Overall incidence of withdrawal movements was significantly lower in the nitrous oxide group (1 patients; 3.1%) than in the oxygen group (8 patients; 25.8%) (P = 0.013). No patient in the nitrous oxide group displayed arm or generalized movement (grade 3 or 4) associated with rocuronium injection.
Conclusions:
This study demonstrated that a combination of inhaled 50% N(2)O in O(2) and 1 mg/kg lidocaine pretreatment significantly reduced the incidence of rocuronium-induced withdrawal movements in pediatric patients compared with lidocaine pretreatment alone.
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