Tags

Type your tag names separated by a space and hit enter

Effects of cisatracurium in children during halothane-nitrous oxide anesthesia.
J Clin Anesth. 1998 May; 10(3):195-9.JC

Abstract

STUDY OBJECTIVE

To determine the neuromuscular blocking effect and recovery profile of cisatracurium besylate in children after administration of a bolus dose that was twice the estimated dose required to produce 95% of the maximum effect (2 x ED95; 0.08 mg/kg) followed by an infusion during halothane-nitrous oxide anesthesia.

STUDY DESIGN

Open-label study.

SETTING

Teaching hospital.

PATIENTS

30 male and female (ASA physical status I and II) patients, 2 to 10 years of age, scheduled for elective surgery of low to moderate risk.

INTERVENTIONS

After induction of general anesthesia, patients received cisatracurium 0.08 mg/kg administered over 5 to 10 seconds. For surgical procedures requiring neuromuscular block for at least 60 minutes, a second bolus dose of cisatracurium 0.02 mg/kg was administered after the first response to a train-of-four stimuli (T1) recovered to 25% of baseline. When T1 was 5% of baseline after the second dose, a 3 microg/kg/min infusion of cisatracurium was initiated and titrated to maintain 89% to 99% block for the duration of the surgery. For procedures requiring neuromuscular block of less than 60 minutes, one or more maintenance doses of 0.02 mg/kg cisatracurium were administered when T1 was 25% of baseline after the preceding dose. In 10 patients, recovery was facilitated with edrophonium 1.0 mg/kg administered when T1 was 26% to 48% of the final baseline.

MEASUREMENTS AND MAIN RESULTS

Evoked muscular response at the adductor pollicis was measured by electromyography. With 0.08 mg/kg, onset time (mean +/- SEM) was 4.1 +/- 0.4 minutes, and clinically effective duration was 27.3 +/- 0.9 minutes. Mean 5% to 95% and 25% to 75% recovery indices were 28.4 +/- 2. 7 minutes and 11.2 +/- 0.8 minutes, respectively. The mean infusion rate necessary to maintain 89% to 99% T1 suppression for 17 to 145 minutes was 1.7 microg/kg/min. After termination of infusion, the mean 5% to 95% and 25% to 75% recovery indices were similar to those after a single bolus dose, and time to 95% recovery was 30.4 +/- 3.0 minutes. After administration of edrophonium, full recovery (T4:T1 > or = 70%) occurred in 1.5 +/- 0.4 minutes. No clinically significant changes in heart rate or blood pressure were noted during the first 5 minutes after administration of cisatracurium 0.08 mg/kg.

CONCLUSIONS

Cisatracurium provided maximal neuromuscular block, cardiovascular stability, and predictable recovery at the doses tested. In view of this finding, cisatracurium should be a useful intermediate-duration neuromuscular blocking drug for children during general anesthesia.

Authors+Show Affiliations

Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Pittsburgh, PA 15213, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

9603588

Citation

Brandom, B W., et al. "Effects of Cisatracurium in Children During Halothane-nitrous Oxide Anesthesia." Journal of Clinical Anesthesia, vol. 10, no. 3, 1998, pp. 195-9.
Brandom BW, Woelfel SK, Ference A, et al. Effects of cisatracurium in children during halothane-nitrous oxide anesthesia. J Clin Anesth. 1998;10(3):195-9.
Brandom, B. W., Woelfel, S. K., Ference, A., Dayal, B., Cook, D. R., & Kerls, S. (1998). Effects of cisatracurium in children during halothane-nitrous oxide anesthesia. Journal of Clinical Anesthesia, 10(3), 195-9.
Brandom BW, et al. Effects of Cisatracurium in Children During Halothane-nitrous Oxide Anesthesia. J Clin Anesth. 1998;10(3):195-9. PubMed PMID: 9603588.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of cisatracurium in children during halothane-nitrous oxide anesthesia. AU - Brandom,B W, AU - Woelfel,S K, AU - Ference,A, AU - Dayal,B, AU - Cook,D R, AU - Kerls,S, PY - 1998/5/29/pubmed PY - 1998/5/29/medline PY - 1998/5/29/entrez SP - 195 EP - 9 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 10 IS - 3 N2 - STUDY OBJECTIVE: To determine the neuromuscular blocking effect and recovery profile of cisatracurium besylate in children after administration of a bolus dose that was twice the estimated dose required to produce 95% of the maximum effect (2 x ED95; 0.08 mg/kg) followed by an infusion during halothane-nitrous oxide anesthesia. STUDY DESIGN: Open-label study. SETTING: Teaching hospital. PATIENTS: 30 male and female (ASA physical status I and II) patients, 2 to 10 years of age, scheduled for elective surgery of low to moderate risk. INTERVENTIONS: After induction of general anesthesia, patients received cisatracurium 0.08 mg/kg administered over 5 to 10 seconds. For surgical procedures requiring neuromuscular block for at least 60 minutes, a second bolus dose of cisatracurium 0.02 mg/kg was administered after the first response to a train-of-four stimuli (T1) recovered to 25% of baseline. When T1 was 5% of baseline after the second dose, a 3 microg/kg/min infusion of cisatracurium was initiated and titrated to maintain 89% to 99% block for the duration of the surgery. For procedures requiring neuromuscular block of less than 60 minutes, one or more maintenance doses of 0.02 mg/kg cisatracurium were administered when T1 was 25% of baseline after the preceding dose. In 10 patients, recovery was facilitated with edrophonium 1.0 mg/kg administered when T1 was 26% to 48% of the final baseline. MEASUREMENTS AND MAIN RESULTS: Evoked muscular response at the adductor pollicis was measured by electromyography. With 0.08 mg/kg, onset time (mean +/- SEM) was 4.1 +/- 0.4 minutes, and clinically effective duration was 27.3 +/- 0.9 minutes. Mean 5% to 95% and 25% to 75% recovery indices were 28.4 +/- 2. 7 minutes and 11.2 +/- 0.8 minutes, respectively. The mean infusion rate necessary to maintain 89% to 99% T1 suppression for 17 to 145 minutes was 1.7 microg/kg/min. After termination of infusion, the mean 5% to 95% and 25% to 75% recovery indices were similar to those after a single bolus dose, and time to 95% recovery was 30.4 +/- 3.0 minutes. After administration of edrophonium, full recovery (T4:T1 > or = 70%) occurred in 1.5 +/- 0.4 minutes. No clinically significant changes in heart rate or blood pressure were noted during the first 5 minutes after administration of cisatracurium 0.08 mg/kg. CONCLUSIONS: Cisatracurium provided maximal neuromuscular block, cardiovascular stability, and predictable recovery at the doses tested. In view of this finding, cisatracurium should be a useful intermediate-duration neuromuscular blocking drug for children during general anesthesia. SN - 0952-8180 UR - https://www.unboundmedicine.com/medline/citation/9603588/Effects_of_cisatracurium_in_children_during_halothane_nitrous_oxide_anesthesia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0952818098000075 DB - PRIME DP - Unbound Medicine ER -