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Intubating conditions and time course of rocuronium-induced neuromuscular block in children
1Department of Anaesthesiology, Pharmacology, and Surgical Intensive Care, Geneva University Hospital, Switzerland.
Insights
Rocuronium at 2xED95 and 3xED95 provides good to excellent intubating conditions for rapid sequence induction in children. Both doses are clinically acceptable, with higher doses leading to deeper neuromuscular block and longer duration.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Rapid sequence induction (RSI) is critical for pediatric anesthesia.
- Rocuronium is a commonly used neuromuscular blocking agent.
Purpose of the Study:
- To evaluate the efficacy of two different doses of rocuronium (2xED95 and 3xED95) for RSI in children.
- To assess intubating conditions and neuromuscular block characteristics.
Main Methods:
- A study involving 100 children aged 3-7 years undergoing elective surgery.
- Rocuronium was administered at 0.6 mg kg-1 (2xED95) or 0.9 mg kg-1 (3xED95).
- Intubating conditions were assessed using a standard score; neuromuscular block was monitored via electromyography in a subset of patients.
Main Results:
- All 70 patients in the intubation assessment group had good to excellent intubating conditions.
- The 3xED95 dose resulted in a deeper neuromuscular block compared to 2xED95.
- Onset time, clinical duration, and duration to 75% recovery were significantly longer with 3xED95.
Conclusions:
- Both 2xED95 and 3xED95 doses of rocuronium provide clinically acceptable intubating conditions for pediatric RSI.
- The higher dose (3xED95) offers a deeper and longer-lasting neuromuscular block.
Abstract:
We have investigated the potential of rocuronium 0.6 mg kg-1 (2xED95) and 0.9 mg kg-1 (3xED95) for rapid sequence induction in 100 children, aged 3-7 yr. Intubating conditions with the two different doses of rocuronium were assessed in 70 children (n = 35 in each group) undergoing elective surgery. Intubation was carried out by mimicking rapid sequence induction, and intubation conditions were evaluated according to a standard score. Intubating conditions were good to excellent in all 70 patients investigated (2xED95: excellent 29, good 6; 3xED95: excellent 33, good 2). In another 30 children (n = 15 in each group), we examined the times of rocuronium-induced neuromuscular block using electromyography. Lag time and recovery index did not differ significantly between the two groups (lag time: 37 (SD 12) vs 33 (14) s; recovery index: 9 (3) vs 10 (4) min). Three times the ED95 induced deeper neuromuscular block, 1 min after injection compared with 2xED95 (twitch height: 42 (24) vs 25 (19)%, respectively; P < 0.05). The same was true for onset time (193 (47) vs 118 (23) s; P < 0.01), clinical duration (21 (4) vs 34 (11) min; P < 0.01) and duration to 75% recovery (30 (6) vs 44 (4) min; P < 0.01). By mimicking rapid sequence induction, both doses of rocuronium offered clinically acceptable (good or excellent) intubating conditions.