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Pharmacodynamics and intubating conditions of cisatracurium in children during halothane and opioid anesthesia.
J Clin Anesth. 2000 May; 12(3):173-6.JC

Abstract

STUDY OBJECTIVES

To determine the pharmacodynamics and intubating conditions of cisatracurium 0.2 mg/kg in children aged 2 to 12 years.

DESIGN

Open-label, randomized study.

SETTING

Operating room of a university-affiliated hospital.

PATIENTS

42 ASA physical status I and II patients, 24 to 155 months of age.

INTERVENTIONS

Patients were assigned to one of two groups: halothane anesthesia (G1) and opioid anesthesia (G2). Subsequently, each group was divided into two age subgroups: 24-59 months and 60-155 months. All patients were premedicated with midazolam intranasal 0.1 to 0.2 mg/kg. In G1, anesthesia was induced with halothane up to 3% and N(2)O/O(2) (60-70/30-40%). Halothane was reduced to </=2%, 2 minutes before cisatracurium was administered. In G2, anesthesia was induced with fentanyl 2 mcg/kg and thiopental 5 mg/kg. Anesthesia was maintained with halothane 0.8-1.5% in N(2)O/O(2) in G1, and it was maintained with fentanyl, thiopental, and N(2)O/O(2) in G2. Electromyography (EMG) assessed the neuromuscular function of the adductor pollicis every 10 seconds with single-twitch supramaximal stimulus at induction and train-of-four at recovery. After obtaining EMG baseline, cisatracurium was administered. Onset time, time to 90% block, percentage of maximal block, clinical duration, and intubating conditions were recorded. For statistical analysis, Chi-square test, analysis of variance, and Tukey's test were used, with p-value less than 0.05.

MEASUREMENTS AND MAIN RESULTS

Only first twitch (T(1)) recovery to 25% was significantly longer in patients aged 24 to 59 months who received halothane-based anesthesia, compared with those who received opioid-based anesthesia (p < 0.05). Onset time, maximum block, and intubating conditions did not differ between groups (p > 0.05).

CONCLUSIONS

Cisatracurium 0.2 mg/kg offered acceptable intubating conditions at 90 seconds in 98% of pediatric patients, regardless of the anesthesia-based technique. Longer clinical duration in the halothane group in younger children may be due to age-related potentiation or to the small number of patients enrolled in the younger subgroup.

Authors+Show Affiliations

Department of Anesthesiology, University of Miami/Jackson Memorial Medical Center, Miami, FL 33101, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10869913

Citation

Kenaan, C A., et al. "Pharmacodynamics and Intubating Conditions of Cisatracurium in Children During Halothane and Opioid Anesthesia." Journal of Clinical Anesthesia, vol. 12, no. 3, 2000, pp. 173-6.
Kenaan CA, Estacio RL, Bikhazi GB. Pharmacodynamics and intubating conditions of cisatracurium in children during halothane and opioid anesthesia. J Clin Anesth. 2000;12(3):173-6.
Kenaan, C. A., Estacio, R. L., & Bikhazi, G. B. (2000). Pharmacodynamics and intubating conditions of cisatracurium in children during halothane and opioid anesthesia. Journal of Clinical Anesthesia, 12(3), 173-6.
Kenaan CA, Estacio RL, Bikhazi GB. Pharmacodynamics and Intubating Conditions of Cisatracurium in Children During Halothane and Opioid Anesthesia. J Clin Anesth. 2000;12(3):173-6. PubMed PMID: 10869913.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacodynamics and intubating conditions of cisatracurium in children during halothane and opioid anesthesia. AU - Kenaan,C A, AU - Estacio,R L, AU - Bikhazi,G B, PY - 2000/6/28/pubmed PY - 2000/8/6/medline PY - 2000/6/28/entrez SP - 173 EP - 6 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 12 IS - 3 N2 - STUDY OBJECTIVES: To determine the pharmacodynamics and intubating conditions of cisatracurium 0.2 mg/kg in children aged 2 to 12 years. DESIGN: Open-label, randomized study. SETTING: Operating room of a university-affiliated hospital. PATIENTS: 42 ASA physical status I and II patients, 24 to 155 months of age. INTERVENTIONS: Patients were assigned to one of two groups: halothane anesthesia (G1) and opioid anesthesia (G2). Subsequently, each group was divided into two age subgroups: 24-59 months and 60-155 months. All patients were premedicated with midazolam intranasal 0.1 to 0.2 mg/kg. In G1, anesthesia was induced with halothane up to 3% and N(2)O/O(2) (60-70/30-40%). Halothane was reduced to </=2%, 2 minutes before cisatracurium was administered. In G2, anesthesia was induced with fentanyl 2 mcg/kg and thiopental 5 mg/kg. Anesthesia was maintained with halothane 0.8-1.5% in N(2)O/O(2) in G1, and it was maintained with fentanyl, thiopental, and N(2)O/O(2) in G2. Electromyography (EMG) assessed the neuromuscular function of the adductor pollicis every 10 seconds with single-twitch supramaximal stimulus at induction and train-of-four at recovery. After obtaining EMG baseline, cisatracurium was administered. Onset time, time to 90% block, percentage of maximal block, clinical duration, and intubating conditions were recorded. For statistical analysis, Chi-square test, analysis of variance, and Tukey's test were used, with p-value less than 0.05. MEASUREMENTS AND MAIN RESULTS: Only first twitch (T(1)) recovery to 25% was significantly longer in patients aged 24 to 59 months who received halothane-based anesthesia, compared with those who received opioid-based anesthesia (p < 0.05). Onset time, maximum block, and intubating conditions did not differ between groups (p > 0.05). CONCLUSIONS: Cisatracurium 0.2 mg/kg offered acceptable intubating conditions at 90 seconds in 98% of pediatric patients, regardless of the anesthesia-based technique. Longer clinical duration in the halothane group in younger children may be due to age-related potentiation or to the small number of patients enrolled in the younger subgroup. SN - 0952-8180 UR - https://www.unboundmedicine.com/medline/citation/10869913/Pharmacodynamics_and_intubating_conditions_of_cisatracurium_in_children_during_halothane_and_opioid_anesthesia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0952-8180(00)00132-X DB - PRIME DP - Unbound Medicine ER -