Related Experiment Videos
Vecuronium infusion requirements in paediatric patients in intensive care units: the use of acceleromyography
1Division of Anaesthetics, United Medical and Dental School, Guy's Hospital, London.
Insights
Infants require significantly less vecuronium infusion for neuromuscular block in the ICU. Acceleromyography monitoring ensures safe and effective drug administration, preventing muscle weakness.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Pediatric Anesthesiology
Background:
- Neuromuscular blocking drugs in ICUs can lead to complications like prolonged block and muscle weakness, especially in infants due to scarce data.
- Inappropriate infusion rates and inadequate monitoring of neuromuscular block (NMB) exacerbate these risks in pediatric populations.
- Acceleromyography offers a potentially more reliable method for monitoring NMB in the ICU setting.
Purpose of the Study:
- To establish appropriate vecuronium infusion rates for neonates, infants, and children undergoing mechanical ventilation in the ICU.
- To evaluate the efficacy and safety of acceleromyography for monitoring neuromuscular block in this patient group.
- To compare vecuronium requirements and recovery times between neonates/infants and older children.
Main Methods:
- A study involving 12 neonates/infants and 18 children to determine optimal vecuronium infusion rates.
- Vecuronium infusion adjusted to maintain a train-of-four (TOF) response of 1 using acceleromyography (TOF guard).
- Recovery time measured by spontaneous TOF ratio recovery to 0.7 post-infusion cessation.
Main Results:
- Neonates and infants required 45% less vecuronium (54.7 µg/kg/h) compared to older children (98.7 µg/kg/h).
- Faster recovery to a TOF ratio of 0.7 was observed in neonates/infants (45 min) versus children (65 min).
- No evidence of prolonged muscle weakness was noted in either group.
Conclusions:
- Routine monitoring of neuromuscular block is crucial in ICUs for safe drug administration.
- Acceleromyography is a convenient and reliable tool for monitoring neuromuscular block in pediatric intensive care.
- Optimized vecuronium infusion rates are essential for infants to prevent complications and ensure adequate recovery.
Abstract:
Neuromuscular blocking drugs in intensive care units (ICU) may cause complications, including prolonged neuromuscular block as a result of overdosage and post-ventilation muscle weakness. These may be increased by using inappropriately high infusion rates for infants, in whom published studies are scarce, and by failure to monitor neuromuscular block. There is little ICU experience of acceleromyography, which may permit more reliable monitoring. To determine appropriate vecuronium infusion rates, 12 neonates/infants (median age 4 (interquartile range (IQR) 2-5) months) and 18 children (median age 3.07 (2-10 yr) were studied. The vecuronium infusion rate was adjusted to maintain train-of-four (TOF) at 1 response using the TOF guard accelerometer. Recovery time was measured from cessation of infusion until spontaneous TOF ratio recovery of 0.7. Neonates and infants required 45% less vecuronium (mean infusion rate 54.7 (SEM 4.23) micrograms kg-1 h-1) than older children (98.7 (7.07) micrograms kg-1 h-1) and had faster recovery to 70% T4/T1 (45 (IQR 20-51) min vs 65 (55-103) min), with no evidence of prolonged weakness. Routine monitoring of neuromuscular block in ICU is essential; acceleromyography is convenient and reliable.