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Neuromuscular effects of rocuronium in children during halothane anaesthesia
D Vuksanaj1, B Skjonsby, B S Dunbar
1Department of Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, Houston 77030, USA.
Insights
Rocuronium bromide offers rapid neuromuscular blockade and intermediate duration in children aged 4-12 years. This study confirms its efficacy and safety for intubation, with minimal cardiovascular side effects.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Rocuronium bromide is a nondepolarizing muscle relaxant with established efficacy in adults and young children.
- Its pharmacokinetic and pharmacodynamic profile in older children requires further elucidation.
Purpose of the Study:
- To evaluate the onset time, intubating conditions, and duration of action of rocuronium in children aged 4 to 12 years.
- To assess the safety and side effect profile of rocuronium in this pediatric population.
Main Methods:
- A prospective study involving children aged 4-12 years undergoing nitrous oxide-halothane anesthesia.
- Rocuronium bromide (600 mcg/kg IV) was administered after stable train-of-four (TOF) monitoring.
- Neuromuscular blockade and recovery were assessed using TOF stimulation at the ulnar nerve.
Main Results:
- The time to 90% and 100% neuromuscular block was 51 ± 18 s and 66 ± 32 s, respectively.
- Intubation conditions were rated as good or excellent in all patients within 94 ± 31 s.
- Recovery of neuromuscular transmission to 25%, 75%, and 90% occurred at 29 ± 8 min, 42 ± 14 min, and 46 ± 16 min, respectively.
- A transient heart rate increase of approximately 12 BPM was observed, with no significant change in blood pressure.
Conclusions:
- Rocuronium bromide demonstrates a rapid onset and intermediate duration of action in children aged 4-12 years.
- It provides excellent intubating conditions with a favorable safety profile, showing no significant adverse cardiovascular effects.
Abstract:
Rocuronium bromide, a nondepolarizing muscle relaxant has been shown to have a short onset and intermediate duration of action in adults and young children. We evaluated onset time, intubating conditions, as well as duration of action of rocuronium in children ages four to 12 years during nitrous oxide-halothane anaesthesia. Following a stable recording of train-of-four (TOF) impulses at the ulnar nerve, patients were given rocuronium 600 micrograms.kg-1 intravenously. We found that the time to 90% and 100% neuromuscular (N-M) block of the (TOF) was 51 +/- 18 s and 66 +/- 32 s respectively. Intubation was achieved at 94 +/- 31 s and rated as good or excellent in all cases. Time to recovery of N-M transmission to 25%, 75% and 90% of control was 29 +/- 8 min, 42 +/- 14 min and 46 +/- 16 min respectively. Heart rate increased approximately 12 BPM after drug injection, while the blood pressure remained unchanged. From our data we conclude that, as in other age groups, rocuronium has a rapid onset, intermediate duration of action in children 4-12 years of age, and appears devoid of significant side effects.