Tracheal intubating conditions and pharmacodynamics following cisatracurium in infants and children undergoing halothane and thiopental-fentanyl anesthesia.
BACKGROUND
The aims of the present study were to determine the tracheal intubating conditions, onset time, duration of action, and hemodynamic responses following the administration of cisatracurium 0.15 mg x kg(-1) to infants and children.


METHODS
One hundred and eighty-one infants and children aged 1 month to 12 years were randomized to two groups to receive anesthesia with nitrous oxide-oxygen-halothane (group H) or nitrous oxide-oxygen-thiopental-fentanyl (group TF). Intubation conditions were assessed 120 s after cisatracurium administration using a 4-part scale. Neuromuscular transmission was monitored by recording the evoked compound electromyogram of the adductor pollicis.


RESULTS
The proportion of patients with excellent or good intubating conditions was similar in both groups (88 of 90, 98% in group H; 85 of 90, 94% in group TF). However, there was a significantly greater proportion of excellent intubating conditions in group H (79 of 90, 88%) compared with group TF (65 of 90, 72%) (P = 0.01) and recovery time was significantly longer in group H compared with group TF (P < 0.001). There was also a higher proportion of excellent intubating conditions in infants compared with older subjects (P = 0.02) and a shorter onset time (P < 0.001) and longer recovery time (P < 0.001) in younger compared with older patients. Changes in heart rate and arterial pressure were negligible 1 min following the cisatracurium administration.


CONCLUSIONS
Cisatracurium 0.15 mg x kg(-1) produces acceptable intubating conditions at 120 s in the great majority of infants and children. Anesthesia background and age have significant effects on intubating conditions and duration of action of cisatracurium.
Meakin
George H
GH
Department of Anaesthesia, Royal Manchester Children's Hospital, Pendlebury, Manchester, UK. george.meakin@manchester.ac.uk
Meretoja
Olli A
OA
Perkins
Russell J
RJ
Waite
Ian
I
Taivainen
Tomi
T
Wirtavuori
Kari
K
Murphy
Anthony K
AK
Raiha
Leena
L
D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001279:Atracurium / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004576:Electromyography / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006221:Halothane / Q000008:administration & dosage*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects / Q000494:pharmacology; D009609:Nitrous Oxide / Q000008:administration & dosage; D010100:Oxygen / Q000008:administration & dosage; D013874:Thiopental / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D009466:Neuromuscular Blocking Agents; D001279:Atracurium; D013874:Thiopental; D009609:Nitrous Oxide; C101584:cisatracurium; D010100:Oxygen; D005283:Fentanyl; D006221:Halothane