title: Postoperative neuromuscular block following atracurium or alcuronium in children.
abstract: Postoperative neuromuscular block (NMB) was evaluated in 60 children who received randomly either atracurium or alcuronium to induce and maintain an 85-95 per cent NMB during balanced anaesthesia. The EMG-monitor was turned away from the anaesthetist 10-15 min before the end of surgery. The average NMB was comparable between the groups at the time of reversal with neostigmine 50 micrograms.kg-1 (84 +/- 9 per cent, mean +/- SD) as were the NMB and the train-of-four ratio when the tracheas were extubated on a clinical basis (32 +/- 20 per cent and 50 +/- 18 per cent, respectively). Patients who had been paralyzed with atracurium arrived at the recovery room earlier and on arrival had greater train-of-four ratios than the patients paralyzed with alcuronium (P less than 0.01). Time to a train-of-four ratio of greater than 90 per cent was significantly shorter in the atracurium group (10 +/- 5 min vs 26 +/- 15 min, P less than 0.001). Thus, an intermediate-acting muscle relaxant offers a safer recovery profile of the NMB than a long-acting muscle relaxant in paediatric patients.
authors.affiliation: Department of Anaesthesiology, Childrenhs Hospital, University of Helsinki, Finland.
authors.forename: O A
authors.initials: OA
authors.lastname: Meretoja
authors.forename: R
authors.initials: R
authors.lastname: Gebert
mesh_terms: D000293:Adolescent; D000443:Alcuronium / Q000494:pharmacology*; D000768:Anesthesia, General; D001279:Atracurium / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D004576:Electromyography / Q000187:drug effects; D005071:Evoked Potentials / Q000187:drug effects; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D009388:Neostigmine / Q000627:therapeutic use; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000502:physiology; D011184:Postoperative Period; D012044:Regression Analysis; D009435:Synaptic Transmission / Q000187:drug effects* / Q000502:physiology; D013997:Time Factors
chemical_list: D001279:Atracurium; D009388:Neostigmine; D000443:Alcuronium