title: Increased cis-atracurium requirements during prolonged administration to a child.
abstract: OBJECTIVE
  To report increase infusion requirements of cis-atracurium during prolonged infusion (six weeks) to provide neuromuscular blockade in a child during prolonged mechanical ventilation. Despite a previous study in adult patients which demonstrated no increase in infusion requirements over five days, we noted a considerable increase over six weeks.
  
  
  METHODS
  A seven month old infant required prolonged mechanical ventilation and neuromuscular blockade following an episode of multi-system organ failure from pseudomembranous colitis. The infusion of cis-atracurium was adjusted according to the train-of-four response obtained with a peripheral nerve stimulator using standard train-of-four monitoring. Initial infusion requirements which were 2.8 micrograms.kg-1 min-1 on day #1 increased to 22.3 micrograms.kg-1 min-1 on day #40.
  
  
  CONCLUSIONS
  Increased infusion requirements were necessary during the prolonged administration of cis-atracurium to a critically ill infant. Titration of the dose based on monitoring with a peripheral nerve stimulator is recommended.
authors.affiliation: Department of Child Health, University of Missouri, Columbia 65212, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D001279:Atracurium / Q000008:administration & dosage*; D016638:Critical Illness; D004558:Electric Stimulation / Q000295:instrumentation; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007536:Isomerism; D008991:Monitoring, Physiologic / Q000295:instrumentation; D009102:Multiple Organ Failure / Q000209:etiology; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D012121:Respiration, Artificial
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium