Histamine Release During the Administration of Atracurium or Vecuronium in Children

Abstract

The histamine releasing potential of equivalent bolus doses of atracurium 0.6 mg kg-1 or vecuronium 0.12 mg kg-1 was evaluated in 20 children anaesthetized with halothane. Blood samples were obtained before, and at 2 and 5 min after the administration of the neuromuscular blocker. The twitch response to 0.15 Hz was also evaluated. None of the 10 patients receiving vecuronium had a significant increase in plasma histamine concentration. In two of the 10 children receiving atracurium, the plasma histamine concentration increased markedly, but without any apparent clinical manifestations. Recovery of neuromuscular function (to 95% twitch height) after vecuronium 0.12 mg kg-1 was faster than after atracurium 0.6 mg kg-1 (P less than 0.02).

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

“…This has also recently been reported for higher doses of these drngs. 9 The shorter duration of vecuronium may also retlect the use of a less than equipotent dose of the drug. The ED95 of 35 izg.kg -L adopted for this study has also been reported as high as 64 jxg'kg-t using a single dose technique ~~ and also, using a cumulative method, 56 ~g-kg-t. 2 The recovery time to TI/Tc 25 per cent for atracurium 0.4 mg-kg -I, under similar anaestheiic conditions, using EMG monitoring has been reported as 23 minutes t3~4 but, in other studies, as long as 37.6 minutes z which is similar to our finding of 39 37.5 minutes.…”

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

“…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 .…”

“…For the comparative outcome analysis of t25, a 26‐node treatment network was produced from 48 studies (41 RCTs and 7 CCTs) with 164 study arms, including 3224 pediatric participants 43–90 …”

The Role of Histamine in the Cardiovascular Effects of Atracurium

“…Cardiovascular reactions after administration of atracurium are still controversial, being classified differently by various investigators. Several investigators found no significant cardiovascular changes with doses of atracurium 0.2-0.4 mg kg" 1 [3,21,22,26] and in isolated cases even with 0.5 mg kg" 1 [27]. Dose dependence was investigated further by Hilgenberg and Stoelting using atracurium 0.2 and 0.4 mg kg" 1 [21], Scott and colleagues using 0.6 and 0.8 mg kg" 1 [18,19] and by Tryba and colleagues [1], as mentioned above.…”