Vecuronium In Children Research Articles

Antagonize vecuronium-induced residual neuromuscular blockade with neostigmine in pediatric and adult patients

Objective To study the dose-effect relationships and safety for neostigmine as antagonist of vecuronium-inducted residual neuromuscular blockade in children and adults.Methods The first dose of vecuronium was 0.1 mg&g.bolus doses of 0.05 mg/kg vecuronium were injected into 50 children and 50 adult patients as clinically needed during surgery.At an acceleromyography train-of-four ratio(TOFR)recovery of 0.55,neostigmine(10,20,30 or 50 μg/kg)and atropine(5,10,15 or 25 μg/kg)were administrated by random allocation.Group contr01 was administrated saline 2 m1.Time of TOFR recovery of 0.7.0.9 and 1.0 and complication of postoperative nausea and vomiting(PONV)in 6 and 24 hours were also recorded.Results Neostigmine accelerated the recovery of TOFR.It was significant different that the recovery time of four doses of neostigmine compared to group control(P＜0.01),especially the dose of 30 μg/kg～50 μg/kg(P＜0.05).There was no difference in dose-response relationships for neostigmine and the incidence of PONV in 6 hours and 24 hours between pediatric and adult patients(P＞0.05).At the fifth minute after antagonism,ED95 of neostigmine was(6.4±10.5)μg/kg and(2.7±1 9.2)μg/kg respectively in children and adult patients.Conclusion Different doses of neostigrnine ale equally effective against vecuronium in children and adult patients at TOFR recovery of 0.55.Low dose of neostigmine,no more than 30 μg/kg,is suitable for antagonizing residual neuromuscular blockade. Key words: Neostigmine; Antagonism; Vecuronium; Residual neuromuscular blockade; Anesthesia

Different small-dose remifentanil blunting the cardiovascular response to laryngoscopy and intubation in children

The available data provide inconsistent results on the efficacy of small-dose remifentanil attenuating the cardiovascular response to intubation in children. Therefore, this randomized double-blind study was designed to assess the ability of different small doses of remifentanil on the cardiovascular intubation response in children, with the aim of determining the optimal dose of remifentanil for this purpose. One hundred and twenty-four children aged 3-9 yr were randomized to one of four groups to receive the following in a double-blind manner: normal saline (Group 1), remifentanil 0.75 microg kg(-1) (Group 2), remifentanil 1 microg kg(-1) (Group 3) and remifentanil 1.25 microg kg(-1) (Group 4). Non-invasive blood pressure and heart rate were recorded before anaesthesia induction (baseline value), immediately before intubation (postinduction values), at intubation and at 1 min intervals for 5 min after intubation. Tracheal intubation caused significant increases in systolic blood pressure and heart rate in Groups 1-3 compared with the baseline values. The maximum percent increases of systolic blood pressure and heart rate were 10% and 26% of the baseline values, respectively, in Group 2; 5% and 14% in Group 3; and 1% and 8% in Group 4 compared with 27% and 37% in Group 1. Except for the Group 3 vs. Group 4 comparison, there were significant differences among the four groups in the maximum percent increases of systolic blood pressure and heart rate. When used as part of anaesthesia induction with propofol and vecuronium in children, bolus administration of remifentanil resulted in a dose-related attenuation of the cardiovascular intubation response.

Pharmacokinetics and Pharmacodynamics of Vecuronium in Children Receiving Phenytoin or Carbamazepine for Chronic Anticonvulsant Therapy

Pharmacokinetics and Pharmacodynamics of Vecuronium in Children Receiving Phenytoin or Carbamazepine for Chronic Anticonvulsant Therapy

Pharmacokinetics and pharmacodynamics of vecuronium in children receiving phenytoin or carbamazepine for chronic anticonvulsant therapy

The pharmacokinetics and time course of action of vecuronium in normal children and children receiving anticonvulsant drugs for prolonged periods were characterized. A bolus dose of vecuronium 0.15 mg kg(-1) was administered i.v. to 10 non-epileptic children and to 10 children on phenytoin and 10 children on carbamazepine, who were matched for age and weight. Plasma concentrations of vecuronium, 3-OH desacetylvecuronium (the primary metabolite of vecuronium) and alpha1-acid glycoprotein (AAG) were determined. Pharmacokinetic variables were derived from plasma samples collected before and after administration of vecuronium. Neuromuscular transmission was monitored by evoked compound electromyography. Recovery of the first twitch of the train-of-four (T1/T0) and the recovery index (RI), the time for 25-75% recovery of T1/T0, were determined. The elimination half-life of vecuronium was significantly reduced in both anticonvulsant groups compared with control [control 48.2 (SD 40.3), phenytoin 23.5 (13.1), carbamazepine 18.4 (16.6) min, P<0.05]. Vecuronium clearance was increased in both anticonvulsant groups [control 9.0 (3.6), phenytoin 15.1 (8.9), carbamazepine 18.8 (13.1) ml kg(-1) min(-1), 0.05<P<0.1]. Children on chronic anticonvulsant therapy had a significantly shorter RI than control [control 21.8 (11), phenytoin 12.5 (8.3), carbamazepine 10.6 (5.9) min, P<0.05]. Concentrations of vecuronium at different degrees of recovery of T1, volumes of distribution and AAG concentrations were not different between groups. Our data confirm anticonvulsant-induced resistance to vecuronium in children and support a pharmacokinetic component contributing to the resistance.

Continuous infusion of vecuronium in children.

The average dose of vecuronium required in children continuous infusion to attain a steady state block of 90% was determined. The electromyographic (EMG) response and mechanical response to supramaximal stimulation of the ulnar never recorded simultaneously, were significantly correlated in four children. The steady-state infusion rate requirement of vecuronium was 1.4 +/- 0.03 micro g/kg/min during 2% enflurane anesthesia and 3.1 +/- 0.03 micro g/kg/min during 1% halothane anesthesia. The spontaneous recovery time to 25% of the control by EMG during halothane and enflurane anesthesia was 12.6 +/- 1.1 and 10.3 +/- 1.5 min, respectively, after termination of the infusion. There was no cumulative effect after prolonged vecuronium infusion.

Influence of Inhalation Anaesthetics on the Pharmacodynamics of Atracurium and Vecuronium in Children

Influence of Inhalation Anaesthetics on the Pharmacodynamics of Atracurium and Vecuronium in Children