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The dose response effect of long-acting nondepolarizing neuromuscular blocking agents in children
Insights
Pancuronium, metocurine, d-tubocurarine, and gallamine neuromuscular relaxants were compared in children. Pancuronium demonstrated the highest potency and fastest recovery, suggesting potential advantages in pediatric anesthesia.
Area of Science:
- Anesthesiology
- Pharmacology
- Pediatric Critical Care
Background:
- Neuromuscular blocking agents are crucial in pediatric anesthesia for intubation and surgical relaxation.
- Understanding the dose-response and recovery profiles of different relaxants is essential for safe and effective use in children.
Purpose of the Study:
- To compare the potency and recovery characteristics of four neuromuscular blocking agents: pancuronium, metocurine, d-tubocurarine, and gallamine.
- To establish effective doses for 95% twitch depression and assess recovery times in pediatric patients.
Main Methods:
- Cumulative dose-response curves were generated for pancuronium, metocurine, d-tubocurarine, and gallamine in 56 anesthetized children.
- The effective dose (ED95) for 95% twitch depression at 0.1 Hz was determined for each agent.
- Recovery times from 5-25% of control twitch height were measured.
Main Results:
- Pancuronium was the most potent (0.08 mg/kg ED95), followed by metocurine (0.34 mg/kg), d-tubocurarine (0.6 mg/kg), and gallamine (3.4 mg/kg).
- Pancuronium exhibited significantly faster recovery (15.6 min) compared to metocurine (27.3 min), d-tubocurarine (32.2 min), and gallamine (30 min).
- Children showed a trend towards requiring higher relaxant doses but faster recovery compared to adults, though not statistically significant.
Conclusions:
- Pancuronium is significantly more potent and offers faster recovery than metocurine, d-tubocurarine, and gallamine in pediatric anesthesia.
- These findings support the use of pancuronium for its favorable potency and recovery profile in pediatric surgical settings.
- Pediatric patients may have distinct neuromuscular relaxant requirements and recovery patterns compared to adults, warranting further investigation.
Abstract:
Cumulative dose-response curves were constructed for pancuronium, metocurine, d-tubocurarine and gallamine in 56 children anaesthetized with thiopentone, N2O/O2 and narcotic. The dose response curves of the four relaxants did not deviate significantly from parallelism. The effective dose causing 95 per cent depression of the twitch at 0.1 Hz was: pancuronium 0.08 mg X kg-1, metocurine 0.34 mg X kg-1, d-tubocurarine 0.6 mg X kg-1, and gallamine 3.4 mg X kg-1. Thus, pancuronium is 40 times more potent than gallamine, while metocurine and d-tubocurarine are seven and four times more potent than gallamine. The recovery of twitch height from 5-25 per cent of control for pancuronium (15.6 +/- 1.7 min) was significantly faster (p less than 0.01) than metocurine (27.3 +/- 1.9 min), d-tubocurarine (32.2 +/- 4.8 min), or gallamine (30 +/- 3.3 min). Compared to studies in adults, the present data indicate that children have a tendency (statistically not significant) to require more relaxant and recover more quickly than adults.