Tempo de latência e duração do efeito do rocurônio, atracúrio e mivacúrio em pacientes pediátricos

Módolo, Norma Sueli Pinheiro; Júnior, Paulo do Nascimento; Croitor, Lorena Brito da Justa; Vianna, Pedro Thadeu Galvão; Castiglia, Yara Marcondes Machado; Ganem, Eliana Marisa; Bráz, José Reinaldo Cerqueira; Takito, Daniela Suemi; Takaesu, Luciano Akira

doi:10.1590/s0034-70942002000200006

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…The use of reversal agent after administration of mivacurium in normal patients is not necessary due to the rapidity of spontaneous recovery [5]. In addition, mivacurium is considered to cause mild to moderate histamine release, but its release is less in children as compared to adults [6]. Because of its rapid onset, short duration of action, lack of accumulation, short recovery, and relative lack of adverse effects, mivacurium was chosen for cases of short duration and pediatric surgery.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of mivacurium in pediatric patients

et al. 2017

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BackgroundMivacurium is the shortest acting nondepolarizing muscle relaxant currently available; however, the effect of different dosages and injection times of intravenous mivacurium administration in children of different ages has rarely been reported. This study was aimed to evaluate the muscle relaxant effects and safety of different mivacurium dosages administered over different injection times in pediatric patients.MethodsSix hundred forty cases of pediatric patients, aged 2 m-14 years, ASA I or II, were divided into four groups (Groups A, B, C, D) according to the age class (2–12 m, 13–35 m, 3–6 years and 7–14 years) respectively, also each group were divided into four subgroups by induction dose (0.15, 0.2 mg/kg in 2–12 m age class; 0.2, 0.25 mg/kg in other three age classes), and mivacurium injection time (20 s, 40 s), totally 16 subgroups. Neuromuscular transmission was monitored with supramaximal train-of-four stimulation of the ulnar nerve. Radial artery blood (1 ml) was sampled to quantify plasma histamine concentrations before and 1, 4, and 7 min after mivacurium injection (P0, P1, P2 and P3).ResultsFive hundred sixty-two cases completed the study. There were no demographic differences within the four groups. The onset time of 0.2 mg/kg groups in 2–12 m aged patients were shorter than those of 0.15 mg/kg groups (189 ± 64 s vs. 220 ± 73 s, 181 ± 60 s vs. 213 ± 71 s, P <0.05), and the recovery times were no statistical differences. The T1 25% recovery time of 0.2 mg/kg in 3–6 years aged patients was shorter than that of 0.25 mg/kg group (693 ± 188 s vs. 800 ± 206 s, P <0.05). The onset and recovery times of mivacurium were not different in 13–35 m and 7–14 years aged patients. The plasma concentrations of histamine at P0, P1, P2 and P3 were not different within four groups.ConclusionsThe induction dose and injection time of mivacurium had mostly insignificant effects on onset and recovery times. The main exception to this was that in 2–12 m aged patients, increasing the dose of mivacurium from 0.15 to 0.2 mg/kg accelerated the onset time by about 30 s. Mivacurium produced no significant release of histamine in any age group at the doses studied.Trial registrationClinicalTrials.gov Identifier-NCT02117401, July 14, 2014. (Retrospectively registered)

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Section: Introductionmentioning

confidence: 99%

The efficacy and safety of mivacurium in pediatric patients

et al. 2017

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“…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%

“…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 …”

Section: Resultsmentioning

confidence: 99%

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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