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Pharmacokinetics of rocuronium bromide in paediatric patients
B O'Kelly1, P Fiset, C Meistelman
1Department of Anaesthesia, Bicetre Hospital, France.
Insights
This study found that rocuronium dosing in children is best calculated using weight, not body surface area. Pediatric pharmacokinetic models showed significant differences compared to adults.
Area of Science:
- Pharmacology
- Pediatric Anesthesiology
- Drug Metabolism
Background:
- Rocuronium is a neuromuscular blocking agent used in pediatric anesthesia.
- Accurate dosing is crucial for safe and effective anesthesia in children.
Purpose of the Study:
- To investigate the pharmacokinetics of rocuronium in pediatric patients.
- To compare weight-based versus age-adjusted dosing models for rocuronium in children.
Main Methods:
- Administered rocuronium (0.8 mg kg-1) to 22 children (3 months to 8 years) under N2O/O2/halothane anesthesia.
- Collected blood samples for 360 minutes to determine rocuronium concentrations.
- Fitted pharmacokinetic data to a two-compartment model, comparing weight-proportional and age-adjusted models.
Main Results:
- Pharmacokinetics were best described by a two-compartment model.
- Weight-proportional models indicated volumes and clearances were proportional to weight.
- Age-adjusted models showed only the volume of the second compartment and central clearance were age-proportional.
- The volume of the central compartment was larger in children than in adults.
Conclusions:
- Results do not support using body surface area for pediatric rocuronium dose calculation; weight is preferred.
- Pediatric rocuronium pharmacokinetics differ from adult pharmacokinetics, necessitating specific dosing considerations.
Abstract:
Rocuronium 0.8 mg kg-1 was given to 22 children between the ages of 3 months and 8 years during anaesthesia with N2O/O2, 60:40, and halothane. Blood samples were collected for 360 min for determination of rocuronium concentrations. The pharmacokinetics were best described by a two-compartment model. Two models were fitted, one proportional to weight and the other adjusted for age. Using the first model, volumes and clearances were all proportional to weight: in the second model, only the volume of the second compartment and clearance from the central compartment were proportional to age. The results do not support the use of body surface area, rather than weight for the calculation of paediatric doses of rocuronium. In this study, the volume of the central compartment was larger than the figure obtained in an adult population.