Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000200006
Brazilian Journal of Anesthesiology
Scientific Article

Tempo de latência e duração do efeito do rocurônio, atracúrio e mivacúrio em pacientes pediátricos

Onset time and duration of rocuronium, atracurium and mivacurium in pediatric patients

Norma Sueli Pinheiro Módolo; Paulo do Nascimento Júnior; Lorena Brito da Justa Croitor; Pedro Thadeu Galvão Vianna; Yara Marcondes Machado Castiglia; Eliana Marisa Ganem; José Reinaldo Cerqueira Braz; Daniela Suemi Takito; Luciano Akira Takaesu

http://dx.doi.org/10.1590/S0034-70942002000200006 Braz J Anesthesiol, vol.52, n2, p.185-196, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: Os bloqueadores neuromusculares (BNM) são freqüentemente utilizados em anestesia pediátrica e não existe aquele considerado ideal. O objetivo deste trabalho foi avaliar o rocurônio, o atracúrio e o mivacúrio, em crianças, quanto ao tempo de latência e de recuperação, à interferência sobre as variáveis hemodinâmicas e às condições de intubação traqueal. MÉTODO: Sessenta e sete crianças, estado físico ASA I e II, com idade variando de 2 anos e 6 meses a 12 anos, foram anestesiadas com alfentanil (50 µg.kg-1), propofol (3 mg.kg-1), sevoflurano e N2O/O2 e divididas em três grupos: G1 = rocurônio 0,9 mg.kg-1 (n = 22); G2 = atracúrio 0,5 mg.kg-1 (n = 22) e G3 = mivacúrio 0,15 mg.kg-1 (n = 23). A monitorização do bloqueio neuromuscular foi realizada com o método de aceleromiografia no trajeto do nervo ulnar. Foram estudados: o tempo de latência (TL), a duração clínica (T25), o tempo de relaxamento (T75) e o índice de recuperação (T25-75). A pressão arterial média (PAM) e a freqüência cardíaca (FC) foram registradas em seis momentos, bem como as condições encontradas no momento da intubação traqueal. RESULTADOS: A mediana do TL foi de 0,6 minutos em G1, 1,3 minutos em G2 e 1,9 minutos em G3. A mediana do T25 foi em G1 = 38 minutos, G2 = 41,5 minutos e G3 = 8,8 minutos. A mediana do T75 foi em G1 = 57,7 minutos, G2 = 54,6 minutos e G3 = 13,6 minutos. A mediana do índice de recuperação (T25-75) foi em G1 = 19,7 minutos, G2 = 13,1 minutos e G3 = 4,8 minutos. As condições de intubação traqueal foram consideradas excelentes na maioria dos pacientes de ambos os grupos. Não houve modificações clínicas importantes da PAM e da FC. CONCLUSÕES: O rocurônio, 0,9 mg.kg-1, teve o menor tempo de latência e o mivacúrio, 0,15 mg.kg-1, o menor tempo de recuperação nos pacientes pediátricos anestesiados com sevoflurano. Também, o rocurônio, o mivacúrio e o atracúrio não determinaram alterações hemodinâmicas de importância clínica relevante e proporcionaram excelentes condições de intubação traqueal.

Palavras-chave

ANESTESIA, Pediátrica, BLOQUEADORES NEUROMUSCULARES, Não despolarizantes, BLOQUEADORES NEUROMUSCULARES, Não despolarizantes, BLOQUEADORES NEUROMUSCULARES, Não despolarizantes, MONITORIZAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Neuromuscular blockers (NMB) are widely used in pediatric anesthesia, but there is no ideal NMB. This study aimed at evaluating onset and recovery time, hemodynamic changes and tracheal intubation conditions of rocuronium, atracurium and mivacurium in pediatric patients. METHODS: Participated in this study 67 children aged 30 months to 12 years, physical status ASA I and II, who were allocated into three groups: G1 = 0.9 mg.kg-1 rocuronium (n = 22); G2 = 0.5 mg.kg-1 atracurium (n = 22); G3 = 0.15 mg.kg-1 mivacurium (n = 23). Anesthesia was induced with 50 µg.kg-1 alfentanil, 3 mg.kg-1 propofol, sevoflurane and N2O/O2. Neuromuscular block was monitored by acceleromyography on the ulnar nerve pathway. The following parameters were evaluated: onset time (OT), clinical duration (T25) relaxation time (T75) and recovery time (T25-75). Heart rate (HR) and mean blood pressure (MBP) were recorded in 6 moments, as well as tracheal intubation conditions. RESULTS: Median OT was: G1 = 0.6 min, G2 = 1.3 min, G3 = 1.9 min. Median T25 was: G1 = 38 min, G2 = 41.5, G3 = 8.8 min. Median T75 was: G1 = 57.7 min; G2 = 54.6 min, G3 = 13.6 min. Median T25-75 was: G1 = 19.7 min, G2 = 13.1 min and G3 = 4.8 min. Tracheal intubation conditions were excellent for most children in all groups. There were no significant MBP and HR clinical changes. CONCLUSIONS: Rocuronium (0.9 mg.kg-1) had the fastest onset time and mivacurium (0.15 mg.kg-1) the shortest recovery time in pediatric patients anesthetized with sevoflurane. Rocuronium, mivacurium and atracurium had also not determined significant hemodynamic changes and allowed for excellent tracheal intubation conditions.

Keywords

ANESTHESIA, Pediatric, MONITORING, NEUROMUSCULAR BLOCKERS, Nondepolarizing, NEUROMUSCULAR BLOCKERS, Nondepolarizing, NEUROMUSCULAR BLOCKERS, Nondepolarizing

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