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Effect of Volatile Anesthetics on Vecuronium-Induced Neuromuscular Blockade in Children

Received from the Department of Anesthesia, University Hospital of Geneva, Geneva, Switzerland.

Abstract

We studied 60 children undergoing elective surgery to evaluate the effect of interactions between vecuronium and isoflurane or halothane on the potency and duration of neuromuscular blockade, as measured by electromyography. Vecuronium was first administered by a logarithm-based cumulative method (14, 22, 35, 56, 89 µg/kg) in 10 children anesthetized with thiopental (5 mg/kg), alfentanil (15 µg/kg first dose, then 10 µg/kg), and N₂O/O₂ (60:40) until a 95% ± 2% twitch depression (ED₉₅) was obtained. Thirty children given the same balanced anesthesia were then randomly assigned to three groups (n = 10 in each) to receive a single ED₂₀ (21 µg/kg), ED₅₀ (33 µg/kg), or ED₈₀ (47 µg/kg) intravenous bolus of vecuronium calculated from the mean regression line of twitch responses of the first 10 children. In the second part of the study, 20 children were anesthetized with isoflurane (1.2%) or halothane (0.7%) and compared with the previous 10 children anesthetized with alfentanil-N₂O. Potency of vecuronium determined by single-bolus or logarithm-based cumulative techniques was not significantly different. Isoflurane and halothane significantly decreased ED₅₀ (22.3 ± 1.6 and 25.4 ± 1.4 µg/kg, respectively; mean ± SE) and ED₉₅ (41.5 ± 3.3 and 46.7 ± 3.2 µg/kg, respectively) compared with alfentanil-N₂O (ED₅₀: 32.8 ± 0.8 µg/kg, ED₉₅: 70.5 ± 2.6 µg/kg). Recovery rate from vecuronium-induced neuromuscular blockade was significantly longer with isoflurane than with alfentanil-N₂O or halothane. We conclude that in children single-bolus and logarithm-based cumulative techniques give similar potency estimates for vecuronium. Isoflurane and halothane increase by similar amounts the neuromuscular potency of vecuronium. Finally, the recovery of the vecuronium-induced neuromuscular blockade is significantly prolonged by isoflurane, but not by halothane.

Key Words: ANESTHETICS, ISOFLURANE, HALOTHANE • NEUROMUSCULAR RELAXANTS, VECURONIUM • ANESTHESIA, PEDIATRIC

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