Effect of mivacurium 200 and 250 μg/kg in infants during isoflurane anesthesia: a randomized controlled trial [ISRCTN07742712]

Nava-Ocampo, Alejandro A; Aguirre-Garay, Ferel T; Velázquez-Armenta, E. Yadira; Moyao‐García, Diana

doi:10.1186/1471-2253-1-1

Cited by 4 publications

(7 citation statements)

References 29 publications

(37 reference statements)

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“…Electronic searches yielded 6345 potentially relevant trials, of which 71 (48 RCTs and 23 CCTs) eligible research papers (Figure 1 and Table S1) were identified, encompassing 4319 in the large majority ASA I‐II pediatric participants in 232 study arms 43–112 . We incorporated three RCTs that enrolled only a few ASA III patients 62,64,83 .…”

Section: Resultsmentioning

confidence: 99%

“…Considering the risk of bias assessments, ROBINS‐I for CCTs 28 and RoB‐2 for RCTs, 29 (Figures S3 and S4) only 10/71 (14.1%) of the included trials 45,49–52,70,77,86,89,99 calculated the sample sizes required before starting the investigation.…”

Section: Resultsmentioning

confidence: 99%

“…Considering the risk of bias assessments, ROBINS-I for CCTs 28 and RoB-2 for RCTs, 29 (Figures S3 and S4) only 10/71 (14.1%) of the included trials 45,[49][50][51][52]70,77,86,89,99…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In 57% of these direct comparisons more than one study is involved. For the comparative outcome analysis of different NMBA treatments on tTOF90, a 7-node treatment network was produced from 9 trials (6 RCTs + 3CCTs) 47,49,51,70,83,90,[113][114][115] with 45 study arms, including 961 pediatric participants (Figure 2). Matched patient samples from 3 trials [113][114][115] were used to compare tTOF90 between different treatments within the disconnected network.…”

Section: Part 1 Comparative Outcome Analysis (Main Model)mentioning

confidence: 99%

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Spontaneous recovery from neuromuscular block after a single dose of a muscle relaxant in pediatric patients: A systematic review using a network meta‐analytic and meta‐regression approach

Vanlinthout,

Driessen,

Stolker

et al. 2024

Pediatric Anesthesia

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BackgroundAge‐related differences in the pharmacokinetics and pharmacodynamics of neuromuscular blocking agents (NMBAs) and the short duration of many surgical procedures put pediatric patients at risk of postoperative residual curarization (PORC). To date, the duration of neuromuscular blocking agent effect in children has not been analyzed in a quantitative review. The current meta‐analysis aimed to compare spontaneous recovery following administration of various types and doses of neuromuscular blocking agents and to quantify the effect of prognostic variables associated with the recovery time in pediatric patients.MethodWe searched for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared the time to 25% T1 (t25), from 25% to 75% T1 (RI25–75), and to ≥90% train‐of‐four (tTOF90) neuromuscular recovery between common neuromuscular blocking agent treatments administered as a single bolus to healthy pediatric participants. We compared spontaneous t25, RI25‐75, and tTOF90 between (1) neuromuscular blocking agent treatments and (2) age groups receiving a given neuromuscular blocking agent intervention and anesthesia technique. Bayesian random‐effects network and pairwise meta‐analyses along with meta‐regression were used to evaluate the results.ResultsWe used data from 71 randomized controlled trials/controlled clinical trials including 4319 participants. Network meta‐analysis allowed for the juxtaposition and ranking of spontaneous t25, RI25‐75, and tTOF90 following common neuromuscular blocking agent interventions. For all neuromuscular blocking agents a log‐linear relationship between dose and duration of action was found. With the neuromuscular blocking agent treatments studied, the average tTOF90 (mean[CrI95]) in children (>2–11 y) was 41.96 [14.35, 69.50] and 17.06 [5.99, 28.30] min shorter than in neonates (<28 d) and infants (28 d–12 M), respectively. We found a negative log‐linear correlation between age and duration of neuromuscular blocking agent effect. The difference in the tTOF90 (mean[CrI95]) between children and other age groups increased by 21.66 [8.82, 34.53] min with the use of aminosteroid neuromuscular blocking agents and by 24.73 [7.92, 41.43] min with the addition of sevoflurane/isoflurane for anesthesia maintenance.ConclusionsThe times to neuromuscular recovery are highly variable. These can decrease significantly with age and are prolonged when volatile anesthetics are administered. This variability, combined with the short duration of many pediatric surgical procedures, makes quantitative neuromuscular monitoring mandatory even after a single dose of neuromuscular blocking agent.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Considering the risk of bias assessments, ROBINS-I for CCTs 28 and RoB-2 for RCTs, 29 (Figures S3 and S4) only 10/71 (14.1%) of the included trials 45,[49][50][51][52]70,77,86,89,99…”

Section: Study Characteristicsmentioning

confidence: 99%

Section: Part 1 Comparative Outcome Analysis (Main Model)mentioning

confidence: 99%

See 2 more Smart Citations

Spontaneous recovery from neuromuscular block after a single dose of a muscle relaxant in pediatric patients: A systematic review using a network meta‐analytic and meta‐regression approach

Vanlinthout,

Driessen,

Stolker

et al. 2024

Pediatric Anesthesia

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“…We previously used TOF-Guard to study the time course of the effect of mivacurium. 18 Time to onset of action after mivacurium 250 µg/kg ranged approximately 1 to 5 minutes. This is enough time to obtain multiple data of the onset of action, and therefore modeling will result in being less unbiased and more precise.…”

Section: Discussionmentioning

confidence: 99%

Population Pharmacodynamic Modeling without Plasma Concentrations of Rocuronium in Children

Velázquez-Armenta¹,

Nava-Ocampo²

2002

The Journal of Clinical Pharma

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Using the pharmacodynamic model without plasma concentrations described by Bragg et al, an individual approach resulted in highly variable parameters for rocuronium. Using a population approach of the model, the time course of the effect of an IV bolus dose of 400, 600, and 800 microg/kg of rocuronium was studied. Response was measured by accelerometry (TOF-Guard) in 45 low-risk surgical children, ages 2 to 14 years, who were receiving general anesthesia with isoflurane. Using a Bayesian approach and the software P-PHARM, response (the first twitch of the TOF) was modeled. The apparent rate constant of elimination, the rate constant for equilibrium between plasma and the effect compartment, the sigmoidicity factor of the relationship between drug concentration in the effect compartment and the effect, and the infusion rate that produces 50% of the effect at steady state were obtained. Population and individual post hoc parameters were similar among groups and variability was reduced.

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Mathematical analysis of a pharmacodynamic model without plasma concentrations to extend its applicability

Nava-Ocampo¹,

Shafer²,

Velázquez-Armenta³

et al. 2003

Medical Hypotheses

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Effect of mivacurium 200 and 250 μg/kg in infants during isoflurane anesthesia: a randomized controlled trial [ISRCTN07742712]

Cited by 4 publications

References 29 publications

Spontaneous recovery from neuromuscular block after a single dose of a muscle relaxant in pediatric patients: A systematic review using a network meta‐analytic and meta‐regression approach

Spontaneous recovery from neuromuscular block after a single dose of a muscle relaxant in pediatric patients: A systematic review using a network meta‐analytic and meta‐regression approach

Population Pharmacodynamic Modeling without Plasma Concentrations of Rocuronium in Children

Mathematical analysis of a pharmacodynamic model without plasma concentrations to extend its applicability

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