Infusion of atracurium in neonates, infants and children. A study of dose requirements.
The doses of atracurium (by infusion) required to maintain steady-state (90-95%) neuromuscular block were assessed in 75 children aged 9 days to 17 yr during balanced anaesthesia. Following the intubating dose of atracurium 0.4 mg kg-1 and after the recovery of single twitch to 5-10% of control (monitored by evoked EMG of hypothenar muscle), an infusion of atracurium 0.5 mg kg-1 h-1 was started. In 22 of the patients this initial rate resulted in the desired steady state; 32 patients required one, and 21 required two or more adjustments in rate. The mean single twitch value at steady-state was 6.6 +/- 0.3% (SEM), which is equal to 93% neuromuscular block. The infusion requirement to maintain the steady state neuromuscular block in all paediatric patients more than 1 month old was constant (0.53 +/- 0.01 mg kg-1 h-1). The infusion requirement of neonates up to 1 month old was 25% less (0.40 +/- 0.02 mg kg-1 h-1; P = 0.003). A significant correlation (n = 75, r = 0.76, P less than 0.001) was found between the infusion rate (mg m-2 h-1) and the logarithm of the body surface area.
Kalli
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Department of Anaesthesiology, Children's Hospital, University of Helsinki, Finland.
Meretoja
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OA
D000293:Adolescent; D001279:Atracurium / Q000008:administration & dosage* / Q000494:pharmacology; D001830:Body Surface Area; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D009119:Muscle Contraction / Q000187:drug effects
D001279:Atracurium