The safety and efficacy of cisatracurium 0.15 mg.kg⁻¹ during nitrous oxide–opioid anaesthesia in infants and children

Abstract

SummaryWe studied the neuromuscular and cardiovascular effects of a single, rapidly administered intravenous dose of cisatracurium 0.15 mg.kg 21 in 27 infants (aged 1±23 months) and 24 children (aged 2± 12.5 years). After midazolam premedication, anaesthesia was induced and maintained with thiopental and alfentanil in addition to nitrous oxide in oxygen. Neuromuscular function was monitored by evoked adductor pollicis electromyography. At least 15 min after intubation, each patient received cisatracurium 0.15 mg.kg 21 over 5 s. Complete neuromuscular blockade was produced by this dose in all but one infant. The mean (SD) onset time of maximal blockade was more rapid in infants Once neuromuscular function started to recover, the rate of recovery was similar in both age groups. Changes in blood pressure and heart rate after the administration of cisatracurium were negligible in both age groups. Cisatracurium, at a dose of 0.15 mg.kg 21 , was effective and well tolerated in infants and children.Keywords Anaesthesia: paediatric. Neuromuscular relaxants: cisatracurium. Pharmacodynamics. Cisatracurium is a purified form of one of the 10 stereoisomers of atracurium which, unlike the parent compound, is not associated with dose-dependent histamine release in humans [1±3]. In adults undergoing nitrous oxide±oxygen±opioid anaesthesia, the effective dose to produce 95% twitch depression (ED 95 ) of cisatracurium is 48±53 mg.kg 21 [2,3], and a dose of 0.15 mg.kg 21 (<3 Â ED 95 ) produces good or excellent intubation conditions within 90±120 s [4,5]. The relatively high dose requirement of cisatracurium compared with atracurium for tracheal intubation within 2 min (3 Â ED 95 vs. 2 Â ED 95 ) may be related to the higher potency of cisatracurium, because the latter leads to a slower onset of muscle relaxation [6].There have been relatively few clinical studies of the use of cisatracurium in children, and the highest dose of cisatracurium that was administered in these studies was 0.1 mg.kg 21 [7±9]. Apart from a case report of an infant given cisatracurium 0.86 mg.kg 21 [10], there is no information on the use of cisatracurium in infants and children aged under 2 years. Accordingly, this study was designed to evaluate and compare the neuromuscular and cardiovascular effects of a single large dose of cisatracurium 0.15 mg.kg 21 in 27 infants and 24 children. Methods

A clinical comparative study of two intubating doses of cis-atracurium during general anaesthesia for gynaecological surgery

“…19 Similar findings were also observed by Taivainen T et al, Shahram A et al 12,16 These observations of hemodynamic effects of cisatracurium correlates with the observations of our study where group B ( 0.2 mg/kg=4×ED95) found to be hemodynamically more stable than group A (0.15 mg/kg=3×ED95).…”

“…Taivainen T et al studied safety and efficacy of cisatracurium 0.15 mg/kg during nitrous oxide opioid anaesthesia in infants and children, found that onset of action was more rapid in infants than children and mean clinical duration of action of cisatracurium 0.15 mg/kg loading dose in infants was 43.3±6 minutes while in children was 36.0±5.4 minutes with p value<0.0001. 16 Sarooshian SS et al also found that young patients have more rapid onset of block than elderly patients because of slow biophase equilibration in elderly patients but clinical duration of action i.e. recovery profile was found to be similar between two groups.…”

Neuromuskuläre Blockade mit Cisatracurium bei Säulingen und Kindern Verlauf unter Sevoflurananästhesie

“…Muskelrelaxanzien · Cisatracurium · Elektromyographie · Kinderanästhesie · Pharmakodynamik ten Muskelrelaxanzien wie Atracurium [2] und Cisatracurium [18] beobachtet.…”

“…Bisher liegen nur wenige Daten zu Wirkung von Cisatracurium im Säug-lingsalter vor [3,15,18].Ziel der vorliegenden Untersuchung war es deshalb den Verlauf der neuromuskulären Blockade nach 0,1 mg/kg Cisatracurium unter Inhalationsanästhesie mit Sevofluran bei Säuglingen und Kindern zwischen 2 und 9 Jahren zu vergleichen.…”

“…Es konnte sowohl hinsichtlich der Anschlagszeit als auch der klinischen Wirkdauer und der neuromuskulären Erholung entsprechend einer TOFR von 0,9 eine verän-derte Pharmakodynamik bei Säuglin-gen im Vergleich zu den älteren Kindern festgestellt werden. Diese Ergebnisse decken sich mit denen anderer Untersucher, in denen gezeigt wurde, dass Säug-linge deutlich sensibler auf nichtdepolarisierende Muskelrelaxanzien reagieren als ältere Kinder [4,12,13,14,18].…”