ShangGuan, WangNing, Lian, QingQuan, Li, Jun and Smith, F. Gao (Fang Gao). (2008) Clinical pharmacology of cisatracurium during nitrous oxide-propofol anesthesia in children. Journal of Clinical Anesthesia, Vol.20 (No.6). pp. 411-414. ISSN 0952-8180

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Abstract

Study Objective: To describe, in pediatric patients, the effects of three doses of cisatracurium during nitrous oxide-propofol anesthesia and to determine if larger doses result in faster onset time.
Setting: College hospital.

Subjects: 75 ASA physical status I and II children, aged 15 to 60 months, undergoing surgery for hypospadias or undescendent testis.

Interventions: Patients were randomly assigned to one of three groups according to the dose of cisatracurium: Group A = 0.1 mg/kg (two x effective dose), Group B = 0. 15 mg/kg (three x effective dose), and Group C = 0.2 mg/kg (4 x effective dose).

Measurements: Neuromuscular block was assessed with TOF-Guard (Biometer International, Odense, Denmark) accelerometry. Onset time (from cisatracurium injection to maximal depression of time to first twitch), duration of peak effect (time from cisatracurium injection to 5% recovery of time to first twitch), duration of clinical action (time from cisatracurium injection to 25% recovery of time to first twitch), and recovery index (recovery of time to first twitch from 25% to 75%) were recorded.

Main Results: Cisatracurium had no effect on heart rate or blood pressure at any dose. Compared with Group A, onset times in Groups B and C were shorter; and durations of peak effect and clinical action in Groups B and C were longer (P < 0.01) than those in Group A. There was no difference in recovery index among the three groups. There was no difference in onset times between Groups B and C. Compared with Group B, durations of peak effect and clinical action in Group C were longer (P < 0.05 or P < 0.01).

Conclusion: Four times the effective dose of cisatracurium did not significantly shorten onset time beyond that produced with three times the effective dose in young children. (C) 2008 Elsevier Inc. All rights reserved.

Item Type:	Journal Article
Subjects:	R Medicine > RD Surgery R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Neuromuscular blocking agents, Clinical pharmacology, Neuromuscular transmission -- Effect of drugs on, Anesthetics -- Physiological effect, Pediatric anesthesia
Journal or Publication Title:	Journal of Clinical Anesthesia
Publisher:	Elsevier Inc.
ISSN:	0952-8180
Official Date:	September 2008
Volume:	Vol.20
Number:	No.6
Number of Pages:	4
Page Range:	pp. 411-414
Identification Number:	10.1016/j.jclinane.2008.03.011
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
References:	[1] Hardman JG, Limbird LE, Gilman AG. The pharmacological basic of therapeutics, 10th ed., 3. New York: McGraw-Hill Professional; 2001. p. 3-27. [2] Schwinn DA, Shafer SL. Basic principles of pharmacology related to anesthesia. In: Miller RD, editor. Anesthesia. Beijing: Science Press; 2001. p. 15-47. [3] Woolf RL, Crawford MW, Choo SM. Dose-response of rocuronium bromide in children anesthetized with propofol: a comparison with succinylcholine. Anesthesiology 1997;87:1368-72. [4] Taivainen T, Meakin GH, Meretoja OA, et al. The safety and efficacy of cisatracurium 0.15 mg.kg(−1) during nitrous oxide–opioid anaesthesia in infants and children. Anaesthesia 2000;55:1047-51. [5] Smith CE, van Miert MM, Parker CJ, Hunter JM. A comparison of the infusion pharmacokinetics and pharmacodynamics of cisatracurium, the 1R-cis 1VR-cis isomer of atracurium, with atracurium besylate in healthy patients. Anaesthesia 1997;52:833-41. [6] Imbeault K, Withington DE, Varin F. Pharmacokinetics and pharmacodynamics of a 0.1 mg/kg dose of cisatracurium besylate in children during N2O/O2/propofol anesthesia. Anesth Analg 2006;102:738-43. [7] Gerçek A, Ay B, Dogan V, Kiyan G, Dagli T, Gogus Y. Esophageal balloon dilation in children: prospective analysis of hemodynamic changes and complications during general anesthesia. J Clin Anesth 2007;19:286-9. [8] Bergeron L, Bevan DR, Berrill A, Kahwaji R, Varin F. Concentrationeffect relationship of cisatracurium at three different dose levels in the anesthetized patient. Anesthesiology 2001;95:314-23. [9] Schramm WM, Papousek A, Michalek-Sauberer A, Czech T, Illievich U. The cerebral and cardiovascular effects of cisatracurium and atracurium in neurosurgical patients. Anesth Analg 1998;86:123-7. [10] Doenicke A, Soukup J, Hoernecke R, Moss J. The lack of histamine release with cisatracurium: a double-blind comparison with vecuronium. Anesth Analg 1997;84:623-8. [11] Brandom BW, Woelfel SK, Ference A, Dayal B, Cook DR, Kerls S. Effects of cisatracurium in children during halothane-nitrous oxide anesthesia. J Clin Anesth 1998;10:195-9.
URI:	http://wrap.warwick.ac.uk/id/eprint/29181

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