Use of low-dose rocuronium for intubation of children during volunteer surgery abroad.
BACKGROUND
Low-dose rocuronium (ROC) might improve safety during volunteer surgery abroad (VSA) by facilitating intubation with a lower halothane concentration than is typically used. We hypothesized that 0.25 mg.kg(-1) of ROC would improve intubation conditions during 3% halothane induction and still allow for rapid return to spontaneous ventilation (SV).


METHODS
During Operation Smile's 2002 mission to Honduras, patients aged 3 months-11 years were randomized to receive ROC 0.25 mg.kg(-1) (n = 19), or placebo (n = 23). Induction was with 3% halothane in 100% O(2), with ventilation assisted and controlled when possible, and normocarbia maintained. An i.v. was placed after induction, and ROC or placebo given. Direct laryngoscopy (DL) was performed 3 min later by a blinded laryngoscopist who assessed conditions according to predetermined criteria.


RESULTS
Adequate intubation conditions occurred in 89 and 87% of patients (P = 0.59), and mean times from DL until the return to SV were 9.8 and 4.3 min (P = 0.003), in the ROC and placebo groups, respectively. For the placebo group, the presence of SV at DL was predictive of inadequate intubation conditions (P = 0.006).


CONCLUSIONS
When administering 3% halothane for induction of VSA patients, a high frequency of adequate intubation conditions can be achieved without a relaxant, rendering the known benefits of 0.25 mg.kg(-1) of ROC unapparent. ROC 0.25 mg.kg(-1) does allow rapid return to SV.
Politis
George D
GD
Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA 22908, USA. gdp8a@virginia.edu
Brill
Judith
J
Jones
John
J
D000367:Age Factors; D000732:Androstanols / Q000008:administration & dosage*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D006221:Halothane / Q000008:administration & dosage; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D007826:Laryngismus / Q000209:etiology; D007828:Laryngoscopy; D008493:Medical Missions; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D010100:Oxygen / Q000008:administration & dosage; D010919:Placebos; D012119:Respiration / Q000187:drug effects; D012121:Respiration, Artificial; D000077123:Rocuronium; D012449:Safety; D013514:Surgical Procedures, Operative; D013997:Time Factors
D000732:Androstanols; D018685:Anesthetics, Inhalation; D003473:Neuromuscular Nondepolarizing Agents; D010919:Placebos; D010100:Oxygen; D006221:Halothane; D000077123:Rocuronium