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Dose-response and time-course of effect of rocuronium bromide in paediatric patients
O A Meretoja1, T Taivainen, O Erkola
1Department of Anaesthesiology, Children's Hospital University of Helsinki, Finland.
Insights
Rocuronium doses were lower in infants compared to children and adults. Recovery times for neuromuscular function were similar across all age groups, indicating rocuronium is an intermediate-acting muscle relaxant for all.
Area of Science:
- Pharmacology
- Anesthesiology
- Neuromuscular blockade
Background:
- Rocuronium is a non-depolarizing neuromuscular blocking agent.
- Understanding age-specific dosing and recovery is crucial for safe anesthetic practice.
Purpose of the Study:
- To determine the dose-response and recovery characteristics of rocuronium in infants, children, and adults.
- To compare the neuromuscular blocking effects of rocuronium across different age groups.
Main Methods:
- Dose-response curves and spontaneous recovery of neuromuscular function were assessed.
- Single ED95 doses of rocuronium were administered to 10 infants, 20 children, and 20 adults.
- Neuromuscular block was monitored via adductor pollicis EMG following ulnar nerve stimulation.
Main Results:
- ED95 doses were significantly lower in infants (255 ± 62 µg/kg) compared to children (402 ± 68 µg/kg) and adults (350 ± 78 µg/kg).
- The 25-75% recovery time was similar across groups: infants (6.5 ± 1.8 min), children (5.7 ± 1.8 min), and adults (6.7 ± 1.6 min).
Conclusions:
- Rocuronium exhibits lower ED95 doses in infants compared to older age groups.
- The time course of recovery from neuromuscular blockade is comparable across infants, children, and adults.
- Rocuronium functions as an intermediate-acting muscle relaxant in all studied age groups.
Abstract:
We determined dose-response curves and spontaneous recovery of neuromuscular function following a single ED95 dose of rocuronium in 10 infants (1-11 months old), 20 children (2-12 years old) and 20 adults (20-40 years old) during nitrous oxide-oxygen-thiopentone-alfentanil anaesthesia. Neuromuscular block was recorded as adductor pollicis EMG following a supramaximal train-of-four ulnar nerve stimuli at 10 s intervals. ED95 values were significantly less for infants than for children or adults (255 +/- 62, 402 +/- 68 and 350 +/- 78 micrograms kg-1, respectively, P = 0.0001). Time-course of recovery from an average 94% neuromuscular block was similar in all age groups with a 25-75% recovery time of 6.5 +/- 1.8, 5.7 +/- 1.8 and 6.7 +/- 1.6 min in infants, children and adults, respectively. Thus, rocuronium is an intermediate-acting muscle relaxant in all age groups.