Pipecuronium revisited: dose-response and maintenance requirement in infants, children, and adults.
OBJECTIVE
To compare dose-response relationship and maintenance requirement of pipecuronium in anesthetized infants, children, and adults.


METHODS
Prospective, consecutive sample trial.


METHODS
Operating room at a university hospital.


METHODS
15 infants (1-11 months), 15 children (3-10 years), and 15 adults (35-50 years) of ASA physical status I and II.


METHODS
Anesthesia was induced and maintained with N2O:O2 2:1 and 1 minimum alveolar concentration end-tidal halothane. The neuromuscular function was recorded by adductor pollicis electromyogram evoked by a train-of-four ulnar nerve stimulation at 20 second intervals. An individual cumulative log-probit dose-response curve was established and maintenance requirement of pipecuronium determined. Between-group comparisons were made by analysis of variance and Scheffe F-test.


RESULTS
Dose-response curves were parallel with a dose-requirement of pipecuronium similar in infants and adults (ED95 of 40-42 micrograms/kg) and greater in children (ED95 of 52 micrograms/kg). After 30 minutes of surgical neuromuscular block, pipecuronium was required in each age group at a rate of 0.6 to 0.7 individual ED95 doses per hour to maintain an 85% to 95% neuromuscular block.


CONCLUSIONS
Bolus dose requirement of pipecuronium is greatest in children. Maintenance requirement is related to potency in each age group studied.
Meretoja
O A
OA
Department of Anesthesiology, Children's Hospital University of Helsinki, Finland.
Erkola
O
O
D000328:Adult; D000375:Aging / Q000502:physiology*; D000758:Anesthesia; D018685:Anesthetics, Inhalation; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004576:Electromyography / Q000187:drug effects; D005260:Female; D006221:Halothane; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects; D017300:Pipecuronium / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies
D018685:Anesthetics, Inhalation; D003473:Neuromuscular Nondepolarizing Agents; D017300:Pipecuronium; D006221:Halothane