title: Pharmacodynamics and intubating conditions of cisatracurium in children during halothane and opioid anesthesia.
abstract: OBJECTIVE
  To determine the pharmacodynamics and intubating conditions of cisatracurium 0.2 mg/kg in children aged 2 to 12 years.
  
  
  METHODS
  Open-label, randomized study.
  
  
  METHODS
  Operating room of a university-affiliated hospital.
  
  
  METHODS
  42 ASA physical status I and II patients, 24 to 155 months of age.
  
  
  METHODS
  Patients were assigned to one of two groups: halothane anesthesia (G1) and opioid anesthesia (G2). Subsequently, each group was divided into two age subgroups: 24-59 months and 60-155 months. All patients were premedicated with midazolam intranasal 0.1 to 0.2 mg/kg. In G1, anesthesia was induced with halothane up to 3% and N(2)O/O(2) (60-70/30-40%). Halothane was reduced to </=2%, 2 minutes before cisatracurium was administered. In G2, anesthesia was induced with fentanyl 2 mcg/kg and thiopental 5 mg/kg. Anesthesia was maintained with halothane 0.8-1.5% in N(2)O/O(2) in G1, and it was maintained with fentanyl, thiopental, and N(2)O/O(2) in G2. Electromyography (EMG) assessed the neuromuscular function of the adductor pollicis every 10 seconds with single-twitch supramaximal stimulus at induction and train-of-four at recovery. After obtaining EMG baseline, cisatracurium was administered. Onset time, time to 90% block, percentage of maximal block, clinical duration, and intubating conditions were recorded. For statistical analysis, Chi-square test, analysis of variance, and Tukey's test were used, with p-value less than 0.05.
  
  
  RESULTS
  Only first twitch (T(1)) recovery to 25% was significantly longer in patients aged 24 to 59 months who received halothane-based anesthesia, compared with those who received opioid-based anesthesia (p < 0.05). Onset time, maximum block, and intubating conditions did not differ between groups (p > 0.05).
  
  
  CONCLUSIONS
  Cisatracurium 0.2 mg/kg offered acceptable intubating conditions at 90 seconds in 98% of pediatric patients, regardless of the anesthesia-based technique. Longer clinical duration in the halothane group in younger children may be due to age-related potentiation or to the small number of patients enrolled in the younger subgroup.
authors.affiliation: Department of Anesthesiology, University of Miami/Jackson Memorial Medical Center, Miami, FL 33101, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Kenaan
authors.forename: R L
authors.initials: RL
authors.lastname: Estacio
authors.forename: G B
authors.initials: GB
authors.lastname: Bikhazi
mesh_terms: D000758:Anesthesia; D001279:Atracurium / Q000031:analogs & derivatives* / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D005283:Fentanyl / Q000494:pharmacology*; D006221:Halothane / Q000494:pharmacology*; D006801:Humans; D007442:Intubation, Intratracheal; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D013997:Time Factors
chemical_list: D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium; D005283:Fentanyl; D006221:Halothane