Cisatracurium during halothane and balanced anaesthesia in children.
Cisatracurium, 51W89, is one of the ten stereoisomers of Tracrium which, unlike atracurium, has been reported to have a lack of histamine mediated cardiovascular effects at doses as high as 8 x ED95 in adults. We compared the time-course of neuromuscular effects of 80 micrograms.kg-1 or 100 micrograms.kg-1 cisatracurium during N2O-O2-halothane or N2O-O2-opioid anaesthesia, respectively, in 32 children 2-12 years old. Neuromuscular function was monitored by evoked adductor pollicis EMG. Even-numbered patients (n = 16) were allowed to obtain full spontaneous recovery of neuromuscular function and odd-numbered patients (n = 16) received neostigmine 45 micrograms.kg-1 together with glycopyrrolate at the time of 25% EMG recovery. Data are expressed as median with 10th to 90th percentile range. Cisatracurium had an onset time (time from administration to maximal effect) of 2.2 (1.7-3.8) or 2.3 (1.8-4.9) min, a clinical duration (time to 25% EMG recovery) of 34 (22-40) or 27 (24-33) min, and a spontaneous 25-75% recovery time (time from 25 to 75% EMG recovery) of 11 (9-13) or 11 (7-12) min during halothane or balanced anaesthesia, respectively (NS). Train-of-four ratio recovered to 0.70 in 2.5 (1.8-3.0) or 3.2 (2.1-4.3) min following neostigmine during halothane or balanced anaesthesia, respectively (NS). Changes in blood pressure or heart rate following cisatracurium were negligible. We regard cisatracurium as a safe and promising intermediate duration muscle relaxant the effects of which can easily be reversed with neostigmine.
Meretoja
O A
OA
Department of Anaesthesiology, Children's Hospital, University of Helsinki, Finland.
Taivainen
T
T
Wirtavuori
K
K
D000758:Anesthesia; D000769:Anesthesia, Inhalation; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D005260:Female; D005283:Fentanyl; D006221:Halothane; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D009388:Neostigmine / Q000494:pharmacology; D019148:Neuromuscular Blockade; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000494:pharmacology*; D009469:Neuromuscular Junction / Q000187:drug effects; D009609:Nitrous Oxide; D013874:Thiopental
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D009466:Neuromuscular Blocking Agents; D001279:Atracurium; D009388:Neostigmine; D013874:Thiopental; D009609:Nitrous Oxide; C101584:cisatracurium; D005283:Fentanyl; D006221:Halothane