Effects of Cisatracurium in Children During Halothane-Nitrous Oxide Anesthesia
Study Objective: To determine the neuromuscular blocking effect and recovery profile of cisatracurium besylate in children after administration of a bolus dose that was twice the estimated dose required to produce 95% of the maximum effect (2 × ED 95; 0.08 mg/kg) followed by an infusion during halot...
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| Published in: | Journal of clinical anesthesia Vol. 10; no. 3; pp. 195 - 199 |
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| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Elsevier Inc
01-05-1998
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Study Objective: To determine the neuromuscular blocking effect and recovery profile of cisatracurium besylate in children after administration of a bolus dose that was twice the estimated dose required to produce 95% of the maximum effect (2 × ED
95; 0.08 mg/kg) followed by an infusion during halothane-nitrous oxide anesthesia.
Study Design: Open-label study.
Setting: Teaching hospital.
Patients: 30 male and female (ASA physical status I and II) patients, 2 to 10 years of age, scheduled for elective surgery of low to moderate risk.
Interventions: After induction of general anesthesia, patients received cisatracurium 0.08 mg/kg administered over 5 to 10 seconds. For surgical procedures requiring neuromuscular block for at least 60 minutes, a second bolus dose of cisatracurium 0.02 mg/kg was administered after the first response to a train-of-four stimuli (T
1) recovered to 25% of baseline. When T
1 was 5% of baseline after the second dose, a 3 μg/kg/min infusion of cisatracurium was initiated and titrated to maintain 89% to 99% block for the duration of the surgery. For procedures requiring neuromuscular block of less than 60 minutes, one or more maintenance doses of 0.02 mg/kg cisatracurium were administered when T
1 was 25% of baseline after the preceding dose. In 10 patients, recovery was facilitated with edrophonium 1.0 mg/kg administered when T
1 was 26% to 48% of the final baseline.
Measurements and Main Results: Evoked muscular response at the adductor pollicis was measured by electromyography. With 0.08 mg/kg, onset time (mean ± SEM) was 4.1 ± 0.4 minutes, and clinically effective duration was 27.3 ± 0.9 minutes. Mean 5% to 95% and 25% to 75% recovery indices were 28.4 ± 2.7 minutes and 11.2 ± 0.8 minutes, respectively. The mean infusion rate necessary to maintain 89% to 99% T
1 suppression for 17 to 145 minutes was 1.7 μg/kg/min. After termination of infusion, the mean 5% to 95% and 25% to 75% recovery indices were similar to those after a single bolus dose, and time to 95% recovery was 30.4 ± 3.0 minutes. After administration of edrophonium, full recovery (T
4:T
1 ≥ 70%) occurred in 1.5 ± 0.4 minutes. No clinically significant changes in heart rate or blood pressure were noted during the first 5 minutes after administration of cisatracurium 0.08 mg/kg.
Conclusions: Cisatracurium provided maximal neuromuscular block, cardiovascular stability, and predictable recovery at the doses tested. In view of this finding, cisatracurium should be a useful intermediate-duration neuromuscular blocking drug for children during general anesthesia. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0952-8180 1873-4529 |
| DOI: | 10.1016/S0952-8180(98)00007-5 |