Use of pancuronium in children with congenital heart disease

Dosage of pancuronium required to produce 90% neuromuscular blockade, time of onset of action of pancuronium and changes in heart rate and arterial pressure were evaluated in 30 children with congenital cardiovascular disease during intravenous anesthesia. Neuromuscular blockade was measured using train-of-four stimulation (2 Hz for 2 seconds) and twitch count. The 90% blockade was defined as being one twitch felt on the stretched abducted thumb. In 10 children given 0.03- to 0.01-mg/kg increments of pancuronium at 2-minute intervals the mean (+/-SD) dose required to produce 90% neuromuscular blockade was 0.10 +/- 0.02 mg/kg with a range from 0.08 to 0.14 mg/kg. In 20 children given 0.1 mg/kg of pancuronium, 90% neuromuscular blockade was achieved in 4.45 +/- 1.58 minutes. Children less than 2 years of age did not differ from the older children nor did cyanotic children differ from the acyanotic children. There were no significant changes in heart rate or arterial pressure. In one case bigeminy during intubation was seen. No children had tachycardia after pancuronium.