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Comparison of rocuronium requirement in children with continuous infusion versus intermittent bolus: A randomised
Sheung-Nyoung Choi1, Young-Eun Jang, Ji-Hyun Lee
1From the Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital (S-N C, Y-E J, J-H L, E-H K, J-T K, H-S K), Department of Anaesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea (H-S K).
Insights
Continuous infusion of rocuronium uses less drug during paediatric surgery compared to intermittent bolus injections. This method helps minimize residual neuromuscular blockade in children.
Area of Science:
- Anesthesiology
- Pharmacology
- Pediatric Surgery
Background:
- Minimizing rocuronium administration in pediatric surgery is crucial for reducing residual neuromuscular blockade.
- Residual neuromuscular blockade can lead to postoperative respiratory complications.
Purpose of the Study:
- To compare the total dose of rocuronium required for maintaining muscle relaxation using intermittent bolus injection versus continuous infusion.
- To evaluate the impact of different rocuronium administration methods on recovery times and adverse events.
Main Methods:
- A randomized, single-blind controlled trial involving 66 children undergoing general anesthesia.
- Rocuronium was administered either via intermittent bolus or continuous infusion to maintain a train-of-four (TOF) count of two.
- Primary outcome was the dose of rocuronium administered (μg/kg/min); recovery times and adverse events were also recorded.
Main Results:
- The continuous infusion group required significantly less rocuronium (4.9 μg/kg/min) compared to the intermittent bolus group (6.1 μg/kg/min) (P=0.001).
- There were no significant differences in recovery times (TOF count of four to TOF 0.7 or 0.9) between the two groups.
- The incidence of adverse events was similar between the intermittent bolus and continuous infusion groups.
Conclusions:
- Continuous infusion of rocuronium is more efficient in terms of drug dosage compared to intermittent bolus administration in pediatric surgery.
- Continuous administration may be a preferred method for minimizing rocuronium usage while maintaining adequate neuromuscular blockade.
- Both methods demonstrated comparable safety profiles regarding recovery and adverse events.
Background:
Minimising rocuronium administration during paediatric surgery helps to reduce the incidence of residual muscular blockade.
Objective:
To determine whether intermittent bolus injection (Bolus group) or continuous infusion (group) requires the lesser amount of rocuronium.
Design:
A randomised, single-blind controlled trial.
Setting:
A single university hospital from March to June 2017.
Patients:
Sixty-six children undergoing general anaesthesia.
Interventions:
Dose of rocuronium for maintenance of muscle relaxation in either Bolus or continuous infusion group. Train-of-four (TOF) count of two was maintained during surgery. When TOF count reached three, 0.1 mg kg of rocuronium was administered in Bolus group or infused at an increased rate of 0.1 mg kg h in continuous infusion group.
Main Outcome Measures:
Primary outcome was the dose of rocuronium given (μg kg min). The recovery time from the TOF count four to TOF 0.7 (RT0.7), and 0.9 (RT0.9) were recorded. All adverse events were recorded up to 30 min after extubation.
Results:
Mean (SD) rocuronium dose in the Bolus group was 6.1 (0.9), [95% confidence interval (95% CI) 5.7 to 6.4] μg kg min and 4.9 (1.0), (95% CI 4.6 to 5.3) μg kg min in the continuous infusion group (P = 0.001). RT0.7 was 24.0 (13.7), 95% CI 19.3 to 28.7) min in the Bolus group, and 25.7 (16.0), (95% CI 20.2 to 31.2) min in the continuous infusion group (P = 0.73). RT0.9 was 30.7 (17.1), (95% CI 24.9 to 36.5) min in the Bolus group, and 30.0 (17.6), (95% CI 24.0 to 36.0) min in the continuous infusion group (P = 0.91). The incidence of adverse events was not significantly different between two groups.
Conclusion:
In children undergoing general anaesthesia, the dose of rocuronium given by continuous administration was less than that with intermittent bolus.
Trial Registration:
ClinicalTrials.gov (identifier: NCT03060707).
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