Abstract
Purpose
To determine the effects of a priming technique with respect to onset time and duration of action of rocuronium ( 1.5 × ED95, 2.0 × ED95) in a pediatric patient population.
Methods
Eighty-four children, age one to seven years undergoing elective pediatric surgery, were studied in a randomized controlled trial. Neuromuscular function was assessed by accelerometry in response to single-twitch stimulation to assess onset of neuromuscular block, followed by train-of-four (TOF) stimulation at the wrist every 15 sec. Children were randomly allocated to one of four groups: Groups 1 and 3 received saline placebo, followed one minute later by a single bolus dose of rocuronium 0.45 mg·kg-1 iv (1.5 × ED95) and 0.6 mg kg-1 iv (2.0 x ED95), respectively. Patients in Groups 2 and 4 received an initial dose of rocuronium 0.045 mg·kg-1 iv and 0.06 mg·kg-1 iv, respectively, followed one minute later by rocuronium 0.405 mg·kg-1 and 0.54 mg·kg-1iv, respectively.
Results
Rocuronium priming significantly accelerated the time to maximum rocuronium-induced neuromuscular block when compared to placebo [median (95% confidence interval)]: 122.5 (98-186) vs 92.5 (68-116) sec (1.5 × ED95, Group 1 vs Group 2, P < 0.05) and 85 (60-142) vs 55 (48-72) sec (2.0 × ED95, Group 3 vs Group 4, P < 0.05), respectively. Spontaneous recovery to a TOF-ratio ≥ 0.9 was dose-dependent and not influenced by priming.
Conclusion
Priming accelerated the onset of rocuronium in children. A priming interval of one minute and a cumulative dose of rocuronium 1.5 × ED95 resulted in an onset of neuromuscular block comparable to a single dose of rocuronium (2.0 × ED95).
Objectif
Déterminer les effets d’une technique d’amorçage sur le délai d’installation et la durée d’action du rocuronium (1,5 × ED95, 2,0 × ED95) chez les enfants.
Méthode
Quatre-vingt-quatre enfants âgés de un à sept ans et subissant une chirurgie pédiatrique élective ont été recrutés dans cette étude randomisée contrôlée. La fonction neuromusculaire a été évaluée par accélérométrie en réponse à une stimulation simple afin de mesurer le début du bloc neuromusculaire, suivie par une stimulation en train-de-quatre (TOF) au poignet toutes les 15 sec. Les enfants ont été randomisés en quatre groupes: les groupes 1 et 3 ont reçu un placebo de sérum physiologique, suivi une minute plus tard par une dose unique en bolus de rocuronium 0,45 mg·kg-1 iv (1,5 × ED95) et 0,6 mg kg-1 iv (2,0 × ED95), respectivement. Les patients des groupes 2 et 4 ont reçu une dose initiale de rocuronium 0,045 mg·kg-1 iv et 0,06 mg·kg-1 iv, respectivement, suivie une minute plus tard par du rocuronium 0,405 mg·kg-1 et 0,54 mg·kg-1iv, respectivement.
Résultats
L’amorçage avec le rocuronium a accéléré de façon significative le délai jusqu’au bloc neuromusculaire maximum induit par le rocuronium comparé au placebo [moyenne (intervalle de confiance 95 %)]: 122,5 (98-186) vs 92,5 (68-116) sec (1,5 × ED95, groupe 1 vs groupe 2, P < 0,05) et 85 (60-142) vs 55 (48-72) sec (2,0 × ED95, groupe 3 vs groupe 4, P < 0,05), respectivement. La récupération spontanée d’un ratio TOF ≥ 0,9 était dépendante de la dose et n’a pas été influencée par l’amorçage.
Conclusion
L'amorçage a accéléré le début de l’action du rocuronium chez les enfants. Un intervalle d’amorçage d’une minute et une dose cumulative de rocuronium 1,5 × ED95 a eu pour résultat un délai de bloc neuromusculaire comparable à celui obtenu avec une dose unique de rocuronium (2,0 × ED95).
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An erratum to this article is available at http://dx.doi.org/10.1007/BF03026811.
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Bock, M., Haselmann, L., Böttiger, B.W. et al. Priming with rocuronium accelerates neuromus-cular block in children: a prospective randomized study. Can J Anesth 54, 538–543 (2007). https://doi.org/10.1007/BF03022317
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DOI: https://doi.org/10.1007/BF03022317