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Dose-response relationship and effective time to satisfactory intubation conditions after rocuronium in children
J M Hopkinson1, G Meakin, A McCluskey
1University Department of Anaesthesia, Royal Manchester Children's Hospital, Pendlebury, UK.
Insights
Rocuronium effectively blocks neuromuscular function and facilitates tracheal intubation in children aged 2-12 years. This study determined optimal dosing for neuromuscular blockade and intubation conditions in pediatric anesthesia.
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
- Neuromuscular Blockade
Background:
- Rocuronium is a non-depolarizing neuromuscular blocking agent.
- Its efficacy and safety in pediatric populations require precise characterization.
Purpose of the Study:
- To evaluate the neuromuscular blocking effects of rocuronium.
- To assess intubation conditions following rocuronium administration in children.
- To determine rocuronium's potency and onset/recovery times in pediatric patients.
Main Methods:
- Dose-response studies to determine effective doses (ED50, ED95) for twitch depression.
- Assessment of onset and recovery times after a standard dose (0.6 mg.kg-1).
- Evaluation of intubation conditions at various time points post-rocuronium administration.
Main Results:
- ED50 and ED95 for twitch depression were 151 and 331 µg.kg-1, respectively.
- Mean time to 90% and 100% twitch depression was 42s and 60.3s, respectively.
- Satisfactory intubation conditions were achieved in 90% of children by 61 seconds post-administration.
Conclusions:
- Rocuronium provides effective neuromuscular blockade in children.
- A dose of 0.6 mg.kg-1 facilitates rapid and satisfactory tracheal intubation in pediatric patients.
- The study provides crucial data for rocuronium use in pediatric anesthesia.
Abstract:
We assessed the neuromuscular blocking effects of, and intubation conditions following, rocuronium in 81 children aged 2-12 years. The study was conducted in three parts. Parts 1 and 2 were undertaken during anaesthesia with thiopentone, alfentanil and nitrous oxide. Neuromuscular blockade was evaluated by recording the force of contraction of the adductor pollicis in response to train-of-four stimulation at 2 Hz repeated every 10s. In Part 1 the potency of rocuronium was determined in 15 children using a single dose-response technique; in Part 2 onset and recovery times were determined in six children following rocuronium 0.6 mg.kg-1. In Part 3 of the study, intubation conditions were assessed in five groups of 12 children whose tracheas were intubated 30, 40, 50, 60 and 70s after rocuronium 0.6 mg.kg-1 during anaesthesia with thiopentone. The times to satisfactory intubation conditions in 50% and 90% of children were determined by probit analysis. The effective doses of rocuronium to produce 50% and 95% twitch depression were 151 micrograms.kg-1 (95% confidence intervals: 129-173 micrograms.kg-1) and 331 micrograms.kg-1 (95% confidence intervals: 249-543 micrograms.kg-1), respectively. The mean times (SD) to 90% and 100% depression of control twitch following rocuronium 0.6 mg.kg-1 were 42 (11.8) s and 60.3 (19.3) s, respectively. The times to 5%, 25%, 75% and 90% recovery were 20.5 (3.1) min, 26.1 (4.1) min, 35.1 (5.4) min, and 39.5 (6.4) min, respectively. Intubation conditions were satisfactory in 4/12 children at 30 s, 6/12 at 40 s, 8/12 at 50 s, 11/12 at 60 s and 12/12 at 70 s. The times to satisfactory intubation conditions in 50% and 90% of children after rocuronium 0.6 mg.kg-1 were 38 s (95% confidence intervals: 30-44 s) and 61 s (95% confidence intervals: 55-70 s), respectively.