Intubation in children after 0.3 mg/kg of mivacurium.
OBJECTIVE
To distinguish among potential predictors of early, easy intubation in children, including apnea, neuromuscular block at two sites, and time, after administration of 0.3 mg/kg of mivacurium.


METHODS
Prospective, randomized study.


METHODS
Operating rooms of Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.


METHODS
60 ASA physical status I and II children aged 2 through 7 years, scheduled for elective surgical procedures requiring endotracheal intubation.


METHODS
After premedication with midazolam, general anesthesia was induced with halothane and nitrous oxide, and patients were randomly assigned to one of four groups. Mivacurium 0.3 mg/kg was given and tracheal intubation was begun 45 seconds after its injection, or when apnea, block of the orbicularis oculi, (OO) or block of the adductor pollicis (AP) was noted. Intubation conditions were evaluated by an experienced endoscopist.


RESULTS
The first clinical event after administration of mivacurium 0.3 mg/kg was apnea at 43 seconds (median) (average 48 seconds, SEM 2 seconds) after injection. The difference in the time at which neuromuscular block occurred at the AP (median 75 seconds) (average 77 seconds, SEM 2 seconds) and the OO (median 63 seconds) (average 68 seconds, SEM 4 seconds) was statistically, but not clinically, significantly different. All nine intubations that were begun at least 90 seconds after administration of mivacurium resulted in good or excellent intubation conditions, as did 30 of the 51 intubations started earlier.


CONCLUSIONS
In children, there is no advantage to monitoring neuromuscular function at the OO rather than the AP. After administration of 0.3 mg/kg of mivacurium, a 90-second interval before the start of intubation was a better predictor of good intubation conditions during halothane anesthesia (1% inspired) than were changes in evoked neuromuscular function.
Simhi
E
E
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Pittsburgh, PA 15213-2583, USA.
Brandom
B W
BW
Lloyd
M E
ME
Gronert
B J
BJ
Woelfel
S K
SK
D001049:Apnea / Q000503:physiopathology; D001831:Body Temperature / Q000502:physiology; D002675:Child, Preschool; D004562:Electrocardiography; D005133:Eye Movements / Q000502:physiology; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007546:Isoquinolines; D008297:Male; D000077590:Mivacurium; D016343:Monitoring, Intraoperative; D003473:Neuromuscular Nondepolarizing Agents; D011229:Preanesthetic Medication; D011446:Prospective Studies; D009435:Synaptic Transmission / Q000502:physiology
D007546:Isoquinolines; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium