Spontaneous Recovery of Neuromuscular Function after Atracurium in Pediatric Patients

Meretoja, O. A.; Kalli, I.

doi:10.1213/00000539-198610000-00009

Cited by 16 publications

(11 citation statements)

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“…The influence of the distribution volume of atracurium at different ages, and the possibility of delayed elimination in neonates is only speculative, and has still to be tested in pharmacokinetic studies in the newborn. The results of the present study are in agreement with our previous study, which showed that the recovery index (time elapsed between the single twitch recovery 25 % and 75%) during spontaneous recovery after a bolus dose of atracurium was significantly longer in patients younger than 3 months than in older infants and children [14]. Possibly atracurium, like tubocurarine [15], is effective at a lower plasma concentration in neonates than in older paediatric patients.…”

Section: Discussionsupporting

confidence: 93%

Infusion of Atracurium in Neonates, Infants and Children

Kalli¹,

Meretoja²

1988

British Journal of Anaesthesia

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The doses of atracurium (by infusion) required to maintain steady-state (90-95%) neuromuscular block were assessed in 75 children aged 9 days to 17 yr during balanced anaesthesia. Following the intubating dose of atracurium 0.4 mg kg-1 and after the recovery of single twitch to 5-10% of control (monitored by evoked EMG of hypothenar muscle), an infusion of atracurium 0.5 mg kg-1 h-1 was started. In 22 of the patients this initial rate resulted in the desired steady state; 32 patients required one, and 21 required two or more adjustments in rate. The mean single twitch value at steady-state was 6.6 +/- 0.3% (SEM), which is equal to 93% neuromuscular block. The infusion requirement to maintain the steady state neuromuscular block in all paediatric patients more than 1 month old was constant (0.53 +/- 0.01 mg kg-1 h-1). The infusion requirement of neonates up to 1 month old was 25% less (0.40 +/- 0.02 mg kg-1 h-1; P = 0.003). A significant correlation (n = 75, r = 0.76, P less than 0.001) was found between the infusion rate (mg m-2 h-1) and the logarithm of the body surface area.

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Section: Discussionsupporting

confidence: 93%

Infusion of Atracurium in Neonates, Infants and Children

Kalli¹,

Meretoja²

1988

British Journal of Anaesthesia

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“…In GrA a TOF of 0.5/0.8 was reached after 40/58 minutes. The measured time periods of spontaneous neuromuscular recovery after atracurium with halothane anaesthesia correlate with previously determined data (Goudsouzian et al 1985;Meretoja & Kalli 1986). Neostigmine was necessary in half of the cases since at the end of the operation the criteria for spontaneous recovery (TOF > 0.8) were not fulfilled.…”

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confidence: 79%

Facilitated tracheal intubation in infants: is propofol a safe alternative to atracurium?

Grubhofer

Petcold

Donner

et al. 1993

Pediatric Anesthesia

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Summa yThe conditions for intubation were studied in 28 infants (age 1-14 months, ASA IfiI) after intravenous administration of propofol or atracurium. Anaesthesia was induced via mask with halothane and NzO/Oz.The study propofol group (GrP, n = 14) received a bolus of propofol3.0 rngvkg-', whilst the control atracurium group (GrA, n = 14) received atracurium 0.4 rngkg-l. Intubation conditions were listed as excellent, moderate or impossible in GrP 79%-14%-7% and in GrA 72%-14%-14% respectively. A decrease of mean arterial pressure (GrP-9.17 k 10.8 mmHg, -13%; GrA-9.67 k 15.2 mmHg, -12%) and heart rate (GrP-18 2 21 bpm; GrA-14 k 23 bpm) were seen after induction with halothane. After intubation the mean arterial pressure increased. The increase of heart rate observed after intubation was higher in GrA (GrP +6 rt 8 bpm; GrA +17 k 19 bpm). The same intubation scores found with propofol in comparison with atracurium may be due to the reflex-suppressive and stress-inhibitory effect of propofol. Since excellent conditions for intubation were found with comparable smaller effects on measured haemodynamic parameters, propofol is regarded as a safe alternative to atracurium to facilitate intubation.

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“…1990) which supports the observation that recovery is unaffected by age with atracurium (Brandom et al. 1984; Meretoja & Kalli 1986) but not vecuronium, the action of which is prolonged in infants (Fisher & Miller 1983). The dose‐response relationship of atracurium is age‐dependent in humans (Brandom et al.…”

Section: Introductionsupporting

confidence: 69%