Abstract
Postoperative neuromuscular block (NMB) was evaluated in 60 children who received randomly either atracurium or alcuronium to induce and maintain an 85–95 per cent NMB during balanced anaesthesia. The EMG-monitor was turned away from the anaesthetist 10–15 min before the end of surgery. The average NMB was comparable between the groups at the time of reversal with neostigmine 50 μg · kg−1 (84 ±9 per cent, mean ±SD) as were the NMB and the train-of-four ratio when the tracheas were extubated on a clinical basis (32 ±20 per cent and 50 ±18 per cent, respectively). Patients who had been paralyzed with atracurium arrived at the recovery room earlier and on arrival had greater train-of-four ratios than the patients paralyzed with alcuronium (P < 0.01). Time to a train-of-four ratio of > 90 per cent was significantly shorter in the atracurium group (10 ±5 min vs 26 ±15 min, P < 0.001). Thus, an intermediate-acting muscle relaxant offers a safer recovery profile of the NMB than a long-acting muscle relaxant in paediatric patients.
Résumé
Le bloc neuromusculaire postopératoire (NMB) a été évalué chez 60 enfants avant reçu d’une façon randomisée soil l’atracurium soil l’alcuronium afin d’induire et de maintenir un NMB de 85 à 95 pour cent lors d’ une anesthésie balancée. L’EMG fut tournée de l’anesthésiste 10 à 15 minutes avant la fin de la chirurgie. Le NMB moyen était comparable entre les groupes lors de l’antagonisme avec de la néostigmine 50 μg · kg−1 (84 ±9 pour cent, moyenne ±SD). Il en est de même pour le NMB et le rapport de train-de-quatre quand les trochées furent extubées sur une base clinique (32 ±20 pour cent et 50 ±18 pour cent respectivement). Les patients ayant été paralysés avec l’atracurium sont arrivés plus tôt à la salle de réveil et dès leur arrivée, ils ont présenté des ratios de train-de-quatre plus élevés que ceux des patients paralysés avec l’alcuronium (P < 0.01). Le temps pour atteindre un ratio de train-de-quatre >90 pour cent était significativement plus court chez le groupe atracurium (10 ±5 min vs 26 ±15 min, P < 0.001). Ainsi. un relaxant musculaire à action intermédiate offre un profil de récupération plus sécuritaire pour le NMB que celui d’un relaxant musculaire à longue action chez les patients pédiatriques.
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References
Viby-Mogensen J, Jorgensen BC, Ordning H. Residual curarization in the recovery room. Anesthesiology 1979; 50: 539–41.
Beemer GH, Rozental P. Postoperative neuromuscular function. Anaesth Intensive Care 1986; 14: 41–5.
Bevan DR, Smith CE, Donati F. Postoperative neuromuscular blockade: a comparison between atracurium, vecuronium, and pancuronium. Anesthesiology 1988; 69: 272–6.
Andersen BN, Madsen JV, Schurizek BA, Juhl B. Residual curarization: comparative study of atracurium and pancuronium. Acta Anaesthcsiol Scand 1988; 32: 79–81.
Brull SJ, Silverman DG, Ehrenwerth J. Problems of recovery and residual neuromuscular blockade: pancuronium vs. vecuronium. Anesthesiology 1988; 69: A473.
Howardy-Hansen P, Rasmussen JA, Jensen BN. Residual curarization in the recovery room: atracurium versus gallamine. Acta Anacsthesiol Scand 1989; 33: 167–9.
Shanks CA. Pharmacokinetics of the nondepolarizing neuromuscular relaxants applied to calculation of bolus and infusion dosage regimens. Anesthesiology 1986; 64: 72–86.
Katz RL. Clinical neuromuscular pharmacology of pancuronium. Anesthesiology 1971; 34: 550–6.
Meistelman C, Debaene B, d’Hollander A, Donati F, Saint-Maurice C. Importance of the level of paralysis recovery for a rapid antagonism of vecuronium with neostigmine in children during halothane anesthesia. Anesthesiology 1988; 69: 97–9.
Ali HH, Wilson RS, Savarese JJ, Kitz RJ. The effect of tubocurarine on indirectly elicited train of four muscle response and respiratory measurements in humans. Br J Anaesth 1975; 47: 570–4.
Miller RD. How should residual neuromuscular blockade be detected? Anesthesiology 1989; 70: 379–80.
Pavlin EG, Holle RH, Schoene RB. Recovery of airway protection compared with ventilation in humans after paralysis with curare. Anesthesiology 1989; 70: 381–5.
Waud BE, Waud DR. The margin of safety of neuromuscular transmission in the muscle of the diaphragm. Anesthesiology 1972; 37: 417–22.
Meretoja OA, Kalli I. Spontaneous recovery of neuromuscular function after atracurium in pediatric patients. Anesth Analg 1986; 65: 1042–6.
Lebrault C, Chauvin M, Guirimand F, Duvaldestin P. Antagonism of vecuronium-induced diaphragmatic neuromuscular blockade by neostigmine. Anesthesiology 1988; 69: A513.
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The financial support given by the Paulo Foundation, Helsinki, Finland, is kindly recognized
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Meretoja, O.A., Gebert, R. Postoperative neuromuscular block following atracurium or alcuronium in children. Can J Anaesth 37, 743–746 (1990). https://doi.org/10.1007/BF03006532
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DOI: https://doi.org/10.1007/BF03006532