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Neuromuscular effect of pipecuronium bromide in infants and children during nitrous oxide-alfentanil anesthesia
J F Pittet1, E Tassonyi, D R Morel
1Department of Anesthesia, University Hospital of Geneva, Switzerland.
Insights
Pipecuronium is a neuromuscular blocker used in pediatric anesthesia. Infants require lower doses and experience faster recovery compared to older children.
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
- Neuromuscular Pharmacology
Background:
- Pipecuronium is a non-depolarizing neuromuscular blocking agent.
- Its use in pediatric anesthesia requires careful dose determination based on age.
- Alfentanil-N2O/O2 anesthesia is commonly used in pediatric surgery.
Purpose of the Study:
- To evaluate the neuromuscular effects of pipecuronium in infants and children.
- To determine the effective dose 50 (ED50) and effective dose 95 (ED95) of pipecuronium in different pediatric age groups.
- To assess the recovery time from pipecuronium-induced neuromuscular blockade.
Main Methods:
- 32 pediatric patients (ASA Physical Status 1 and 2) were divided into three age groups: 0-3 months, 3-12 months, and 2-9 years.
- Neuromuscular blockade was measured using electromyography at the ulnar nerve-adductor pollicis muscle.
- Incremental intravenous doses of pipecuronium were administered to achieve 95% twitch depression (ED95).
Main Results:
- Infants (0-3 months and 3-12 months) required significantly lower ED50 and ED95 doses of pipecuronium compared to children (2-9 years).
- ED50 values were 23.7 ± 1.7 µg/kg and 25.8 ± 1.5 µg/kg for the infant groups, versus 45.0 ± 5.8 µg/kg for children.
- Recovery from neuromuscular blockade was significantly faster in infants than in children.
Conclusions:
- Pediatric patients, particularly infants, exhibit age-dependent sensitivity to pipecuronium.
- Lower doses of pipecuronium are effective and lead to quicker recovery in infants compared to older children.
- These findings are crucial for optimizing pipecuronium dosage in pediatric anesthesia.
Abstract:
To determine in infants and children the neuromuscular effect of pipecuronium during alfentanil-N2O/O2 anesthesia, the authors studied 32 ASA Physical Status 1 and 2 pediatric patients undergoing minor elective surgery, divided into three groups according to their age: group 1 included 12 infants, 1.9 +/- 0.2 months old (mean +/- SE; range, 20 days to 3 months), weighing 5.2 +/- 0.3 kg; group 2, 10 infants, 6.1 +/- 0.9 months old (range, 3-11 months), 6.9 +/- 0.4 kg; and group 3, 10 children 5.6 +/- 0.9 yr old (range, 2-9 yr), 19.6 +/- 2.2 kg. Neuromuscular blockade at the ulnar nerve-adductor pollicis muscle was measured by electromyography. Incremental iv doses of pipecuronium were given (one 20 micrograms/kg first dose, followed by 10 micrograms/kg increments) to reach a 95 +/- 2% twitch depression (ED95). In children ED50 and ED95 of pipecuronium were 45.0 +/- 5.8 micrograms/kg (mean +/- SE) and 70.5 +/- 9.3 micrograms/kg, respectively. In 3- to 12-month-old infants ED50 and ED95 were 25.8 +/- 1.5 micrograms/kg and 48.7 +/- 3.5 micrograms/kg, respectively, and both significantly (P less than 0.05) less than those in children. In 0- to 3-month-old infants ED50 and ED95 were 23.7 +/- 1.7 micrograms/kg and 46.5 +/- 2.9 micrograms/kg, respectively, and also significantly (P less than 0.05) less than those measured in children. Time from maximal initial neuromuscular blockade to 75% recovery was 64.5 +/- 8.8 min in children and significantly shorter (P less than 0.05) in the two infant groups (0- to 3-month-old: 38.7 +/- 5.7 min, 3- to 12-month-old: 43.8 +/- 5.3 min, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)