Combination of nitrous oxide and lidocaine to prevent withdrawal after rocuronium in children.
BACKGROUND
Pain at the site of rocuronium injection is a common side-effect in pediatric patients. This prospective, randomized, double-blind study evaluated the efficacy of a combination of nitrous oxide and lidocaine pretreatment on withdrawal response during rocuronium injection in children.


METHODS
Sixty six pediatric patients, ages 5 to 12 years, were randomly assigned to two groups. The oxygen group received 100% oxygen, and the nitrous oxide group received 50% N(2)O in oxygen over 2 min. After anesthesia was induced with 2.5% thiopental sodium 5 mg/kg and manual occlusion of the forearm was performed, 1% lidocaine 1 mg/kg was injected over 15 sec. After the occlusion was released, 0.1% rocuronium 0.6 mg/kg was injected over 5 sec. Patient response to rocuronium injection was graded using a 4-point scale.


RESULTS
Overall incidence of withdrawal movements was significantly lower in the nitrous oxide group (1 patients; 3.1%) than in the oxygen group (8 patients; 25.8%) (P = 0.013). No patient in the nitrous oxide group displayed arm or generalized movement (grade 3 or 4) associated with rocuronium injection.


CONCLUSIONS
This study demonstrated that a combination of inhaled 50% N(2)O in O(2) and 1 mg/kg lidocaine pretreatment significantly reduced the incidence of rocuronium-induced withdrawal movements in pediatric patients compared with lidocaine pretreatment alone.
Kwak
Hyun-Jeong
HJ
Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea.
Chae
Yun Jeong
YJ
Lee
Sook Young
SY
Kim
Young Jun
YJ
Kim
Jong-Yeop
JY