Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children.
BACKGROUND
We studied 120 children aged 2-7 yr in a prospective, randomized, assessor-blinded fashion to define the optimal rocuronium dose which provides a 95% probability of acceptable intubation conditions (ED95TI) during inhalation induction with sevoflurane.


METHODS
After inhalation induction with 8% sevoflurane in 60% nitrous oxide and 40% oxygen, and loss of the eyelash reflex, we administered rocuronium (0.1, 0.15, 0.22, 0.3, or 0.6 mg kg-1) or placebo. We quantified neuromuscular function by stimulation of the ulnar nerve at 0.1 Hz to produce contraction of the adductor pollicis muscle using accelerometry. Intubation conditions were assessed 2 min after test drug injection. The optimal rocuronium dose was defined as the lowest dose, which allowed acceptable intubation conditions in 95% of children (ED95TI).


RESULTS
Two minutes after injection of placebo or rocuronium, intubation conditions were acceptable in 35, 45, 80, 90, 95, and 100% of children, respectively. Rocuronium 0.07 [CI 0.02-0.11], 0.24 [0.19-0.31], and 0.29 [0.23-0.38] mg kg-1 provided 50, 90, and 95% probability of acceptable intubating conditions. When thumb acceleration was depressed by 50% or more, intubating conditions were considered acceptable in 97% of children. Recovery of the train-of-four ratio to 0.8 averaged 12 (7), 16 (7), 24 (7), 24 (8), and 50 (22) min after the respective dose of rocuronium.


CONCLUSIONS
During inhalation induction with 8% sevoflurane in 60% nitrous oxide, rocuronium 0.29 mg kg-1 (ED95) optimizes intubation conditions for surgery of short duration.
Eikermann
M
M
Abteilung für Anästhesiologie und Intensivmedizin, Universität Essen, Hufelandstr. 55, D-45122 Essen, Germany.
Hunkemöller
I
I
Peine
L
L
Armbruster
W
W
Stegen
B
B
Hüsing
J
J
Peters
J
J
D000732:Androstanols / Q000008:administration & dosage*; D018685:Anesthetics, Inhalation; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D006339:Heart Rate; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008738:Methyl Ethers; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D011229:Preanesthetic Medication; D011446:Prospective Studies; D000077123:Rocuronium; D000077149:Sevoflurane; D016037:Single-Blind Method
D000732:Androstanols; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D000077149:Sevoflurane; D000077123:Rocuronium