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Influence of age on the dose-response relationship of atracurium in paediatric patients
1Department of Anaesthesiology, Children's Hospital, University of Helsinki, Finland.
Insights
Atracurium
Area of Science:
- Anesthesiology
- Pharmacology
- Pediatric Critical Care Medicine
Background:
- Atracurium is a neuromuscular blocking agent used in pediatric anesthesia.
- Age-related differences in atracurium pharmacodynamics are not fully understood.
- Understanding these differences is crucial for safe and effective pediatric anesthesia.
Purpose of the Study:
- To evaluate how age influences the dose-response relationship of atracurium in pediatric patients.
- To determine the effective dose of atracurium (ED95) for achieving 95% neuromuscular block across different pediatric age groups.
Main Methods:
- Studied 85 pediatric patients from neonates to adolescents undergoing thiopental-fentanyl-N2O-O2 anesthesia.
- Administered two doses of atracurium to each patient.
- Measured the onset time and determined the ED95 for neuromuscular block using EMG response.
Main Results:
- Atracurium onset time was shortest in neonates and infants, longest in adolescents.
- The ED95 was comparable for neonates and infants (226 µg/kg).
- The ED95 for patients aged 1 year and older was significantly higher (316 µg/kg), representing a 28% increase.
Conclusions:
- Pediatric patients aged 1 year and older require a higher ED95 of atracurium compared to neonates and infants.
- Age significantly influences atracurium's dose-response relationship in pediatric patients.
- Individual neuromuscular monitoring is essential due to variability in response.
Abstract:
To assess the influence of age on the dose-response relationship of atracurium in paediatric patients during thiopental-fentanyl-N2O-O2-anaesthesia, we studied 85 patients from neonates to adolescents. Each patient was given two doses of atracurium: following the maximum EMG response to the first dose of 150 micrograms/kg, an individual second dose was given, to produce exactly 95% neuromuscular block. The onset time of atracurium (time from administration to maximum effect) was shortest in neonates (2.6 min) and infants (3.3 min) and longest in adolescents (5.5 min) (P less than 0.01). The dose-response curves were parallel in all patients aged 3 months or older. The ED95 of atracurium was comparable for neonates and infants (226 micrograms/kg). This was 28% less than the ED95 for patients aged 1 year or older (316 micrograms/kg) (P less than 0.01). The results explain the slightly longer-lasting neuromuscular block in infants as compared to children following a constant atracurium dose in micrograms/kg. The great individual variability of the neuromuscular response, however, indicates that neuromuscular monitoring is essential in paediatric patients.