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
PDF Português
PDF English
Downloads: 0
Views: 972

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

References

Brandom BW. Neuromuscular blocking drugs in pediatric patients. Anesth Analg. 2000;90:S14-S18.

Brandom BW. Neuromuscular blocking drugs. Anesth Clin of North Am. 1991;9:781-800.

Cook DR, Davis PJ, Lerman J. Pharmacology of Pediatric Anesthesia. Smith’s Anesthesia for Infants and Children. 1996:159-212.

Gronert BJ, Brandom BW. Neuromuscular blocking drugs in infants and children. Pediatr Clin North Am. 1994;41:81-101.

Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984;39:1105-1111.

Goldberg ME, Laryani GE, Azad SS. Comparison of tracheal intubating conditions and neuromuscular blocking profiles after intubating doses of mivacurium chloride or succinylcholine in surgical patients. Anesth Analg. 1989;69:93-99.

Almeida MCS. Uso de bloqueadores neuromusculares em pediatria. Rev Bras Anestesiol. 2000;50:470-478.

Silverman DG. Neuromuscular Block in Perioperative and Intensive Care. 1994.

Goudsouzian MD, Parsloe CP. Os novos relaxantes musculares em pediatria. Rev Bras Anestesiol. 1994;44:147-158.

Shorten GD, Grawford WW, St Louis P. The neuromuscular effects of mivacurium chloride during propofol anesthesia in children. Anesth Analg. 1996;83:1170-1175.

Goudsouzian NG, Young ET, Moss J. Histamine release during administration of atracurium or rocuronium in children. Br J Anaesth. 1986;58:1229-1233.

Sarner JB, Brandom BW, Woefel SK. Clinical pharmacology of mivacurium chloride in children during nitrous oxide-halothane and nitrous oxide-narcotic anesthesia. Anesth Analg. 1989;68:116-121.

Goudsouzian NG. Mivacurium in infants and children. Pediatr Anaesth. 1997;7:183-190.

Goudsouzian NG, Alifimoff JK, Eberly C. Neuromuscular and cardiovascular effects of mivacurium in children. Anesthesiology. 1989;70:237-242.

Vianna PTG, Takata IH, Braz JRC. Tempo de latência e duração do efeito do brometo de rocurônio no paciente submetido ao transplante renal. Rev Bras Anestesiol. 2000;50:98-104.

Vianna PTG, Castiglia YMM, Ganem EM. Onset time and intubating conditions of rocuronium and succinylcholine. Br J Anesthesiol Int Issue. 1998:49-54.

Almeida MCS, Dal Mago AJ, Pederneiras SC. Comparação das condições de intubação traqueal com diferentes doses de rocurônio, utilizando a monitorização do músculo orbicular ocular. Rev Bras Anestesiol. 1998;48:468-474.

Cook DR. Can succinylcholine be abandoned?. Anesth Analg. 2000;90:S24-S28.

Funchs-Buder T, Tassonyi E. Entubating conditions and time course of rocuronium induced neuromuscular block in children. Br J Anaesth. 1996;77:335-338.

Woelfel SK, Brandom BW, McGowan FX. Neuromuscular effects of 600 mg.kg-1 of rocuronium in infants during nitrous oxide-halothane anaesthesia. Pediatr Anaesth. 1994;4:173-177.

Stoddart PA, Mather SJ. Onset neuromuscular blockade and intubating conditions one minute after the administration of rocuronium in children. Pediatr Anaesth. 1998;8:37-40.

Woolf RL, Crawford MW, Choo SM. Dose response of rocuronium bromide in children anesthetized with propofol: a comparison with succinylcholine. Anesthesiology. 1987;87:1368-1372.

Meretoya OA, Taivainen T. Time course of potentiation of mivacurium by halothane and isoflurane in children. Br J Anaesth. 1996;76:235-238.

Shorten GD, Crawford MW, St Louis P. The neuromuscular effects of mivacurium chloride during propofol anesthesia in children. Anesth Analg. 1996;82:1170-1175.

Kaplan RF, Garcia M, Hannallah RS. Mivacurium induced neuromuscular blockade during sevoflurane and halothane anaesthesia in children. Can J Anaesth. 1999;42:16-20.

Goudsouzian N, Liu LMP, Gianfriddo BA. Neuromuscular effects of atracurium in infants and children. Anesthesiology. 1985;62:75-79.

Meakin G, Shaw EA, Baker RD. Comparison of atracurium-induced neuromuscular blockade in neonates infants and children. Br J Anaesth. 1998;60:171-178.

Braga AFA, Potério GMB, Braga FSS. Influência do sevoflurano e do isoflurano no bloqueio neuromuscular produzido pelo rocurônio. Rev Bras Anestesiol. 2001;51:2-9.

Vitez TS, Miller RD, Eger El. Comparison in vitro of isoflurane and halothane potentiation of d-tubocurarine and succinylcholine neuromuscular blockades. Anesthesiology. 1974;41:53-56.

Brett RS, Dilger JP, Ylan KF. Isoflurane causes "flickering" of the acetylcholine receptor channel: observations using the patch clamp. Anesthesiology. 1988;69:161-170.

Fox MH, Hunt PC. Prolonged neuromuscular block associated with mivacurium. Br J Anaesth. 1995;74:237-238.

Shorten GCM, Louis PST. Pseudocholinesterase activity and duration of mivacurium-induced neuromuscular blockade in children. Anesth Analg. 1995;80:S444.

Wanlinthout LEH, Booiy LHDI, Van Egmond J. Effects of isoflurane and sevoflurane on the magnitude and time course of neuromuscular block produced by vecuronium, pancuronium and atracurium. Br J Anaesth. 1996;76:389-395.

Wulf H, Ledowski T, Linstedt V. Neuromuscular blocking effects of rocuronium during desflurane, isoflurane and sevoflurane anaesthesia. Can J Anaesth. 1998;45:526-532.

Lowry DW, Mirakhur RK, Carroll MT. Potency and time course of mivacurium block during sevoflurane, isoflurane and intravenous anaesthesia. Can J Anaesth. 1999;46:29-33.

Brandom BW, Stiller RL, Cook DR. Pharmacokinetics of atracurium in anaesthetized infants and children. Br J Anaesth. 1986;58:1210-1215.

Brandom BW, Cook DR, Woelfel SK. Atracurium infusion requirements in children during halothane, isoflurane and narcotic anesthesia. Anesth Analg. 1985;64:471-477.

5dd596bb0e88256f7ec8fca6 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections