Use of atracurium during major abdominal surgery in infants with hepatic dysfunction from biliary atresia

The use of atracurium during major abdominal surgery was assessed in 20 infants with hepatic dysfunction caused by biliary atresia. An initial dose of 0.6 mg kg-1 provided excellent intubating conditions in all patients. Subsequent neuromuscular blockade was monitored with a peripheral nerve stimulator and incremental doses of atracurium were given on reappearance of a single twitch. Neuromuscular conduction was allowed to return at the end of surgery and by careful timing of increments it was necessary to antagonize the neuromuscular blockade in only two patients.