Tracheal intubating conditions and pharmacodynamics following cisatracurium in infants and children undergoing halothane and thiopental‐fentanyl anesthesia

Meakin, G.; Meretoja, O. A.; Perkins, Russell; Waite, I. M.; Taivainen, T.; Wirtavuori, K.; Murphy, A. K.; Raiha, Leena

doi:10.1111/j.1460-9592.2006.02042.x

Cited by 13 publications

(10 citation statements)

References 34 publications

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“…Because of the short circulation times of neonates and infants, muscle relaxants are very rapidly distributed to the effect sites and have short onset times. Therefore, good intubation conditions are established faster in infants than in children or adults (4,24).…”

Section: Indications For Muscle Relaxantsmentioning

confidence: 99%

Neuromuscular block and current treatment strategies for its reversal in children

Meretoja

2010

Pediatric Anesthesia

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Even though neuromuscular blocking agents are an essential part of balanced anesthesia and the risks of residual paralysis are well documented, many anesthetists seldomly monitor neuromuscular block. Classical reversal agent neostigmine is unable to antagonise a deep neuromuscular block and is rather slow to antagonise even a moderate block. These caveats may have introduced a practice to use muscle relaxants mainly for an endotracheal intubation. This review presents current views on the effects of muscle relaxants and their reversal agents in pediatric patients. This may help clinicians to reconsider the value of muscle relaxants during anesthesia in children.

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Section: Indications For Muscle Relaxantsmentioning

confidence: 99%

Neuromuscular block and current treatment strategies for its reversal in children

Meretoja

2010

Pediatric Anesthesia

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“…Rocuronium has shown more influence on lung function in children than cisatracurium [11]. Cisatracurium, as a non-depolarizing neuromuscular relaxant, produces excellent intubation conditions and maintains hemodynamic stability in neonates and children [12]. Sevoflurane combined with neuromuscular relaxant is preferred in infants due to lower hemodynamic and respiratory adverse events [13].…”

Section: Introductionmentioning

confidence: 99%

Minimum Alveolar Concentration of Sevoflurane with Cisatracurium for Endotracheal Intubation in Neonates

Zhang

Wang²,

et al. 2019

Med Sci Monit

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BackgroundSevoflurane inhalation induction is widely used in pediatric anesthesia, but the minimum alveolar concentration for endotracheal intubation (MACEI) when combined with neuromuscular blockade in neonates has been largely unexplored. This study assessed the MACEI of sevoflurane combined with cisatracurium in neonates.Material/MethodsAnesthesia induction was commenced by inhaling 4% sevoflurane with 2 l/min of 100% oxygen via mask. Neonates were administered cisatracurium 0.2 mg/kg followed by adjustment of inspired sevoflurane to target end-tidal concentration based on intubation condition of the preceding subject. When the steady-state end-tidal sevoflurane concentration target was maintained for at least 15 min, endotracheal intubation by direct laryngoscope was performed. The intubation condition was considered failed if either heart rate (HR) after intubation increased by 20% or mean arterial blood pressure (MAP) by 30% or more than that before intubation. Otherwise, the intubation condition was regarded as successful. Dixon’s up-and-down method was used with 0.2% as the step size to determine the target end-tidal sevoflurane concentration.ResultsThe MACEI of sevoflurane combined with cisatracurium in neonates was 2.76±0.24%. Using probit analysis, the 50% effective end-tidal sevoflurane concentration (ED50) for successful condition of endotracheal intubation was 2.61% (95%CI 2.07–2.88%) and the 95% effective end-tidal sevoflurane concentration (ED95) was 3.28% (95%CI 2.95–7.19%). Hypotension and bradycardia occurred in 2 neonates during induction.ConclusionsSevoflurane combined with cisatracurium is feasible and effective for intubation in neonates, and the MACEI of sevoflurane in this subpopulation is 2.76±0.24%. However, cardiovascular adverse effects should be taken into consideration.

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“…If the use of M relaxants is necessary (eg, when PSARP is combined with laparotomy), diagnostic EMS may be performed only after the subsidence of their effects. It is beneficial to use cisatracurium, which is a drug with a wellestimated elimination [16] and also monitor the subsidence of M relaxation using a commonly used neurostimulation device [17,18].…”

Section: Resultsmentioning

confidence: 99%

Influence of anesthesia on the results of intraoperative diagnostic electromyostimulation in patients with anorectal malformation

Mixa

Škába

Kraus

et al. 2011

Journal of Pediatric Surgery

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Tracheal intubating conditions and pharmacodynamics following cisatracurium in infants and children undergoing halothane and thiopental‐fentanyl anesthesia

Abstract: Cisatracurium 0.15 mg x kg(-1) produces acceptable intubating conditions at 120 s in the great majority of infants and children. Anesthesia background and age have significant effects on intubating conditions and duration of action of cisatracurium.

Cited by 13 publications

References 34 publications

Neuromuscular block and current treatment strategies for its reversal in children

Neuromuscular block and current treatment strategies for its reversal in children

Minimum Alveolar Concentration of Sevoflurane with Cisatracurium for Endotracheal Intubation in Neonates

Influence of anesthesia on the results of intraoperative diagnostic electromyostimulation in patients with anorectal malformation

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