Low doses of rocuronium during remifentanil–propofol‐based anesthesia in children: comparison of intubating conditions*

Abstract

The results suggest that 0.3 mg x kg(-1) of rocuronium may be a better low dose than 0.15 mg x kg(-1) of rocuronium for clinically acceptable intubating conditions in pediatric ambulatory surgery during remifentanil-propofol-based anesthesia at the doses used in the study.

The optimal pediatric induction dose of propofol in combination with reduced-dose rocuronium and alfentanil for day-case tonsillectomy in children

“…In the present study, 95% of children had clinically adequate intubating conditions after an induction dose of 2.5 mg kg À1 and 98% after 3.0 mg kg À1 of propofol, which is quite similar to the results found by Oztekin et al [11]. Our results differed from those of Ross et al during halothane anesthesia in children (85%) and of Soltesz et al in adults (86%) with co-induction of desfluran, but with similar reduced-dose rocuronium [8,14].…”

“…Contrary to previous studies attributed to Ross et al and Oztekin et al who used propofol in combination with alfentanil, we had the statistically significant decrease in mean blood pressure immediately after bolus dose of 3.0 mg kg À1 of propofol (Group A = 92 AE 6, B = 88 AE 9, C = 80 AE 7) (P B/ C = 0.0432, P A/C = 0.0345) [8,11]. Decrease was 15% from the baseline, which had no clinical significance.…”

“…The ideal neuromuscular blocking agent in cases of short, elective, day-case surgical procedures, should achieve a clinically acceptable onset time Anesthesia induction for day-case tonsillectomy 1879 of NM block with also acceptable intubating condition, as well as fast neuromuscular recovery without prolonged, residual paralysis [11,21]. Mivacurium has the most proper characteristics for mentioned procedures, but is still not available in all countries.…”

“…Nevertheless, most authors support the use of short acting (mivacurium) or low-dose intermediate-acting muscle relaxants (rocuronium) for elective day-case surgery in cases where neuromuscular blocking agents are not contraindicated [8]. To achieve adequate intubation condition in children, low-dose of rocuronium was tested through different pharmacokinetic and pharmacodynamic properties [9][10][11][12].…”

Endotracheal Intubation Without Neuromuscular Blocking Agents: Is It a Good and Safe Option?

“…In short procedures in which endotracheal intubation is mandatory but muscle relaxation for surgery is not required, such as certain Ear Nose Throat (ENT) and neurosurgical procedures, reduced doses of neuromuscular blocking agents can be used to facilitate the endotracheal intubation. Oztekin et al suggested the use of a reduced dose of rocuronium (0.3 mg/kg) with propofol (2.5 mg/kg) and remifentanil infusion (0.5µg/kg/min) to obtain satisfactory intubating conditions without any cardiovascular instability in pediatric day-case surgery (10). Furthermore, sugammadex, a new agent that allows prompt reversal of both rocuronium and vecuronium, should be kept in my mind for very short procedures as well as certain neuromuscular disorders in which reduced doses of rocuronium can be used to facilitate endotracheal intubation.…”