Intubating Conditions and Onset of Action After Rocuronium, Vecuronium, and Atracurium in Young Children

Abstract

To evaluate muscle relaxant onset times and tracheal intubating conditions, 60 children (ASA physical status I or II) aged 18 to 72 mo were randomly assigned to receive a bolus of either rocuronium 0.6 mg/kg, vecuronium 0.1 mg/kg, or atracurium 0.5 mg/kg. After induction of anesthesia with etomidate 0.2-0.4 mg/kg and fentanyl 1-3 mg/kg, lungs were ventilated with 50% nitrous oxide in oxygen via a face mask. The evoked electromyogram of the adductor pollicis to a train-of-four stimulation every 20 s was monitored. After administration of the muscle relaxant, endotracheal intubation was attempted every 30 s, beginning 30 s after drug administration, until intubation could be achieved with good or excellent conditions. Rocuronium produced acceptable intubating conditions significantly faster (all tracheas intubated within 60 s) compared with vecuronium (120 s) and atracurium (180 s). The quality of intubating conditions at the time of completed intubation was rated significantly better with rocuronium than with vecuronium or atracurium. However, onset to 95% block at the adductor pollicis muscle was not significantly different after rocuronium (92 +/- 46.9 s), vecuronium (112 +/- 33.3 s), or atracurium (134 +/- 57.1 s), and mean neuromuscular block achieved at the point of successful intubation was not complete in all groups. We conclude that clinically acceptable intubating conditions are produced more rapidly with rocuronium than with atracurium or vecuronium.

Comparison of rocuronium and vecuronium in paediatric cardiac surgery, using sevoflurane anaesthesia

“…Consistent with the results of Schieber-G et al7,8 , we also found faster and better intubating conditions with rocuronium, than with vecuronium, at 60 seconds (60.2 ± 20.2 seconds Vs. 88.6 + 41.2 seconds)…”

Neuromuscular recovery following rocuronium bromide single dose in infants

“…In paediatric patients rocuronium has a more rapid onset at the adductor muscles of the larynx than at the adductor pollicis (11,12). Thus, good intubation conditions could be seen before a 100% neuromuscular blockade of peripheral muscles (1,3). However, some children showed ‘poor’ conditions with respect to the position and movement of the vocal cords.…”

“…Rocuronium bromide, a steroid nondepolarizing muscle relaxant, has a rapid onset and an intermediate duration of action in infants, children and adults. Satisfactory intubation conditions are achieved in both infants and children in 60 s following a single dose of rocuronium 2 ED 95 (1–4). In newborn and small infants (age below 4 months) there is clinical evidence of variation in duration and recovery time after a single dose of rocuronium.…”

Should we reconsider awake neonatal intubation? A review of the evidence and treatment strategies

“…Mivacurium is a short acting NMB with a 10 min duration of action and a speed of onset similar to atracurium (92). Rocuronium has a fast speed of onset, comparable to that of suxamethonium, however, it is a long acting NMB with a duration of action similar to vecuronium, although this has not been confirmed in neonatal studies (93,94). The cardiovascular side‐effects of both are minimal.…”