Incidence of residual neuromuscular blockade in children below 3 years after a single bolus of cisatracurium 0.1mg/kg: A quality assurance study.

Abstract

The aim of this quality assurance study was to determine the proportion of patients with residual block (train-of-four (TOF) ratio <0.9) upon conclusion of surgery after a bolus of cisatracurium 0.1mg/kg. It was considered good quality if less than 10% of the study population had residual block upon conclusion of surgery. A total of 40 patients ≤3years of age scheduled for cleft lip and palate repair were consecutively enrolled. They received general anaesthesia with either sevoflurane and fentanyl (n=20) or propofol and remifentanil (n=20). TOF stimulation using acceleromyography was applied on the tibial nerve. Cisatracurium 0.1mg/kg was administered to facilitate tracheal intubation. Three patients (8%; 95% CI: 1.7-21) had a TOF ratio <0.9 at conclusion of surgery, all three receiving sevoflurane. In the sevoflurane group, this corresponded to 16% (95% CI: 3.3-40) of the patients. Mean duration of action of cisatracurium 0.1mg/kg was 119minutes (SD 40) with sevoflurane and 73minutes (SD 29) during total intravenous anaesthesia (P<.001). Onset time of cisatracurium 0.1mg/kg was 166seconds (SD 37) with sevoflurane and 199seconds (SD 60) during total intravenous anaesthesia. We found that 8% of the children had residual neuromuscular blockade (TOF ratio <0.9) after administration of a single bolus of cisatracurium 0.1mg/kg but we cannot exclude that the true proportion is around 20%.