Abstract
Purpose
This study describes the effects of 0.3 mg · kg−1 mivacurium in 180 paediatric patients between the ages of one month and 13 yr.
Methods
Alternate patients at each of two geographic sites received nitrous oxide-halothane or nitrous oxide-opioid anaesthesia. Neuromuscular blockade was monitored by electromyography (Datex NMT). Blood pressure and heart rate were recorded from an automated oscillometer. Tracheal intubation was performed 90 sec after administration of mivacurium and conditions were judged by the Krieg scale.
Results
There was no difference in the time course of block between anaesthetics or geographic sites. The average time to 90% block and 25% recovery was 1.0 min and 8.0 min at one monthvs 2.3 min and 9.8 min at 12.5 yr of age. Intubation conditions were better during opioid (excellent in 92%) than during halothane anaesthesia (excellent in 78%) (P = 0.03). Diaphragmatic movement was less frequent in younger patients (P < 0.001). Intubation conditions did not differ between the two geographic sites. In the first minute after mivacurium, systolic and diastolic blood pressures decreased (P < 0.001) to similar extents in all patients. A transient increase in the redness of the skin of the face, trunk, and/or arms was noted during both anaesthetics (28% of infants, and 61 % of children over five yr of age).
Conclusion
The time course of block produced by mivacurium is more rapid in younger paediatric patients. The time course of mivacurium does not have the transatlantic variation which has been observed for vecuronium. Physiological changes suggestive of histamine release were frequent. Intubation conditions were very likely to be acceptable 90 sec after 0.3 mg · kg−1 mivacurium.
Résumé
Objectif
Cette étude décrit les effet de 0.3 mg · kg−1 de mivacurium chez 180 patients pédiatriques agés de un mois à 13 ans.
Méthodes
Sur deux sites géographiques différents, les patients ont reçu de façon alternative une anesthésie halothane-N2O ou opiacé-N2O. Le bloc neuromusculaire a été surveillé par électromyographie (Datex NMT). La pression artérielle et la fréquence cardiaque ont été enregistrés par un appareil automatique fonctionnant par oscillométrie. Lintubation trachéale a été réalisée 90 sec après l’administration de mivacurium et les conditions évaluées selon l’échelle de Krieg.
Résultats
Il n’y avait pas de différence dans les caractéristiques temporelles du bloc selon l’anesthésie ou selon le site géographique. Le temps moyen pour obtenir 90% de bloc neuromusculaire d’une part et 25% de récupération d’autre part était de 1.0 min et de 8.0 min à l’âge de 1 moisvs 2.3 min et 9.8 min à 12.5 ans. Les conditions d’intubation étaient meilleures sous anesthésie avec opiacé (excellentes = 92%) que sous anesthésie à l’halothane (excellentes = 78%) (P = 0.03). Les mouvements diaphragmatiques étaient moins fréquents chez les patients plus jeunes (P < 0.001). Les conditions d’intubation étaient analogues sur les deux sites géographiques. Durant la première minute après le mivacurium, les pressions systolique et diastolique ont diminué (P < 0.001) de façon analogue chez tous les patients. Une rougeur transitoire de la peau de la figure, du tronc et/ou des bras a été notée durant les deux types d’anesthésies chez 28% des nourrissons et 61% des enfants de plus de 5 ans.
Conclusion
Linstallation du bloc produit par le mivacurium est plus rapide et la durée d’action plus courte chez les patients pédiatriques les plus jeunes. On ne retrouve pas pour le mivacurium les variations transatlantiques de temps, tant pour l’installation que pour la durée du bloc, retrouvées avec le rocuronium. Des changements physiologiques suggestifs de relâche d’histamine sont survenus fréquemment. Les conditions d’intubations avaient toutes les chances d’être acceptables 90 secondes après une dose de 0.3 mg · kg−1 de mivacurium.
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Financial support for this study was received from Glaxo Wellcome Inc.
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Brandom, B.W., Meretoja, O.A., Simhi, E. et al. Age related variability in the effects of mivacurium in paediatric surgical patients. Can J Anaesth 45, 410–416 (1998). https://doi.org/10.1007/BF03012575
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DOI: https://doi.org/10.1007/BF03012575