A comparative evaluation of intubating doses of atracurium, d-tubocurarine, pancuronium and vecuronium in children

Montgomery, Carolyne J.; Steward, David J.

doi:10.1007/bf03010542

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…No other direct comparison between rocuronium and atracurium in children has yet been published, but our results are similar to those of a recent study comparing atracurium and rocuronium in adults [9]. Furthermore, in children of the same age group significant differences in clinical duration and recovery parameters had already been found for atracurium vs. vecuronium, which has a very similar molecular structure to rocuronium [10, 11]. In a review of other studies, which investigated separately either atracurium or rocuronium in young children, results can be found in clinical duration and recovery very similar to our own [4, 5, 7, 8].…”

Section: Introductionsupporting

confidence: 88%

Comparison of time course of neuromuscular blockade in young children following rocuronium and atracurium

Ribeiro¹,

Scheiber²,

Marichal³

1998

Eur J Anaesthesiol

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In order to compare the neuromuscular effects following rocuronium 0.6 mg kg-1 and atracurium 0.5 mg kg-1 30 children aged from 18 to 67 months were studied under the same anaesthetic conditions. After induction of anaesthesia with etomidate and fentanyl, neuromuscular blockade was monitored by recording the electromyographic response of the adductor pollicis muscle to a supramaximal train-of-four (TOF) stimulation of the ulnar nerve at 2 Hz for 2 s at 20-s intervals. Intubation was performed when more than 90% muscle relaxation was achieved, thereafter anaesthesia was maintained with 70% nitrous oxide in oxygen and isoflurane 0.5% end-tidal. Mean onset of action was significantly faster following rocuronium (86 +/- 44.9 s) (mean +/- SD) compared with atracurium (126.3 +/- 61.0 s). Clinical duration with rocuronium was 22.8 +/- 5.31 min and thus significantly shorter than that of atracurium, which was 31.5 +/- 6.01 min. A statistically significant difference between rocuronium and atracurium also had been found for recovery of T1 to 50%, 75% and 90% as well as for the time taken to a TOF ratio of 70%. The recovery index for rocuronium and atracurium was not significantly different with 9.2 +/- 3.43 min and 10.9 +/- 2.65 min, respectively. Thus, rocuronium may be more advantageous than atracurium for short-lasting surgical procedures in young children.

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Section: Introductionsupporting

confidence: 88%

Comparison of time course of neuromuscular blockade in young children following rocuronium and atracurium

Ribeiro¹,

Scheiber²,

Marichal³

1998

Eur J Anaesthesiol

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“…Sensitivity analyses did not show that the inclusion of studies with a high risk of bias 48,55,60,68,74,79,86,93,94,109 affected the conclusions.…”

Section: Credibility Of the Resultsmentioning

confidence: 89%

“…Electronic searches yielded 6345 potentially relevant trials, of which 71 (48 RCTs and 23 CCTs) eligible research papers (Figure 1 and Table S1) were identified, encompassing 4319 in the large majority ASA I‐II pediatric participants in 232 study arms 43–112 . We incorporated three RCTs that enrolled only a few ASA III patients 62,64,83 .…”

Section: Resultsmentioning

confidence: 99%

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Spontaneous recovery from neuromuscular block after a single dose of a muscle relaxant in pediatric patients: A systematic review using a network meta‐analytic and meta‐regression approach

Vanlinthout,

Driessen,

Stolker

et al. 2024

Pediatric Anesthesia

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BackgroundAge‐related differences in the pharmacokinetics and pharmacodynamics of neuromuscular blocking agents (NMBAs) and the short duration of many surgical procedures put pediatric patients at risk of postoperative residual curarization (PORC). To date, the duration of neuromuscular blocking agent effect in children has not been analyzed in a quantitative review. The current meta‐analysis aimed to compare spontaneous recovery following administration of various types and doses of neuromuscular blocking agents and to quantify the effect of prognostic variables associated with the recovery time in pediatric patients.MethodWe searched for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared the time to 25% T1 (t25), from 25% to 75% T1 (RI25–75), and to ≥90% train‐of‐four (tTOF90) neuromuscular recovery between common neuromuscular blocking agent treatments administered as a single bolus to healthy pediatric participants. We compared spontaneous t25, RI25‐75, and tTOF90 between (1) neuromuscular blocking agent treatments and (2) age groups receiving a given neuromuscular blocking agent intervention and anesthesia technique. Bayesian random‐effects network and pairwise meta‐analyses along with meta‐regression were used to evaluate the results.ResultsWe used data from 71 randomized controlled trials/controlled clinical trials including 4319 participants. Network meta‐analysis allowed for the juxtaposition and ranking of spontaneous t25, RI25‐75, and tTOF90 following common neuromuscular blocking agent interventions. For all neuromuscular blocking agents a log‐linear relationship between dose and duration of action was found. With the neuromuscular blocking agent treatments studied, the average tTOF90 (mean[CrI95]) in children (>2–11 y) was 41.96 [14.35, 69.50] and 17.06 [5.99, 28.30] min shorter than in neonates (<28 d) and infants (28 d–12 M), respectively. We found a negative log‐linear correlation between age and duration of neuromuscular blocking agent effect. The difference in the tTOF90 (mean[CrI95]) between children and other age groups increased by 21.66 [8.82, 34.53] min with the use of aminosteroid neuromuscular blocking agents and by 24.73 [7.92, 41.43] min with the addition of sevoflurane/isoflurane for anesthesia maintenance.ConclusionsThe times to neuromuscular recovery are highly variable. These can decrease significantly with age and are prolonged when volatile anesthetics are administered. This variability, combined with the short duration of many pediatric surgical procedures, makes quantitative neuromuscular monitoring mandatory even after a single dose of neuromuscular blocking agent.

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“…in their study. A comparative evaluation of intubation doses of atracurium, d-tubocurarine, pancuronium, and vecuronium in children under halothane A few studies have been done in children examining anaesthesia was performed (15). The mean time to non-depolarizing muscle relaxants to expediate maximum twitch depression ranged from 2.1 min intubation.…”

Section: Discussionmentioning

confidence: 99%

Durability of central venous catheters. A randomized trial in children with malignant diseases

Henneberg

Jungersen

Hole

1996

Pediatric Anesthesia

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This randomized blinded study tested the hypothesis that equipotent doses of vecuronium and mivacurium given in combination could achieve onset times to 90% neuromuscular block (B90) and intubation scores similar to succinylcholine. Thirty children were randomly assigned to one of three groups as follows. Group Sux received a single dose (1 mg·kg −1 ) of succinylcholine followed by normal saline. Group V 1 M 1 received 0.08 mg·kg −1 of vecuronium followed by 0.1 mg·kg −1 of mivacurium. Group V 2 M 2 received 0.16 mg·kg −1 of vecuronium followed by 0.2 mg·kg −1 of mivacurium. Anaesthesia consisted of propofol, fentanyl, and nitrous oxide. Neuromuscular response was monitored by adductor pollicis electromyography (Datex NMT). Sixty s after administration of the first injection, the laryngoscopy began, with the anaesthesiologist scoring the ease of intubation on a four category scale as excellent, good, poor, or inadequate.Time from injection to B90 was 39 (2.6) s after succinylcholine, which was not significantly different from 48 (3.5) s after vecuronium 0.16 mg·kg −1 and mivacurium 0.2 mg·kg −1 (V 2 M 2 ). Mean time to B90 for group V 1 M 1 was 64 (4.7) s, which was significantly different from that in group Sux. The intubation score was 'excellent' for all patients in groups Sux and V 2 M 2 and for only seven of ten patients in group V 1 M 1 .Only combination of vecuronium (0.16 mg·kg −1 ) and mivacurium (0.2 mg·kg −1 ) provided rapid onset of neuromuscular blockade and excellent intubating conditions comparable to succinylcholine 1 mg·kg −1 . This combination did result in prolonged recovery times.

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A comparative evaluation of intubating doses of atracurium, d-tubocurarine, pancuronium and vecuronium in children

Cited by 8 publications

References 16 publications

Comparison of time course of neuromuscular blockade in young children following rocuronium and atracurium

Comparison of time course of neuromuscular blockade in young children following rocuronium and atracurium

Spontaneous recovery from neuromuscular block after a single dose of a muscle relaxant in pediatric patients: A systematic review using a network meta‐analytic and meta‐regression approach

Durability of central venous catheters. A randomized trial in children with malignant diseases

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