Intubation Time Required for Tracheal Intubation with Low-dose Rocuronium in Children with and Without Atropine

Overview

Journal J Anesth

Specialty Anesthesiology

Date 2012 Sep 18

PMID 22983593

Authors

Hyun Jeong Kwak

Sang Kee Min

Bong Ki Moon

Kyung Cheon Lee

Yong Beom Kim

Jong Yeop Kim

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of this study was to determine the intubation time needed to facilitate tracheal intubation (Time(EI)) with a low dose of rocuronium (0.3 mg/kg) during propofol induction, and to determine whether this time was reduced by the administration of atropine.

Methods: Forty-six children, aged 3-10 years, were randomly assigned to receive either saline (control group) or atropine 10 μg/kg (atropine group). Anesthesia was induced with alfentanil 10 μg/kg, propofol 2.5 mg/kg, and rocuronium 0.3 mg/kg. Each Time(EI) at which tracheal intubation was attempted was predetermined according to the up-and-down method. The values of Time(EI) that provided excellent intubation conditions in 50 and 95 % of patients were defined as Time(EI)50 and Time(EI)95, respectively.

Results: Time(EI)50 ± SD was 160 ± 26.2 and 150 ± 13.7 s in the control and atropine groups, respectively. Using isotonic regression, Time(EI)95 in the control and atropine groups was 199 s (95 % CI 198.8-200.7 s) and 171 s (95 % CI 171.3-172.1 s), respectively. Time(EI)95 was significantly higher in the control group than in the atropine group (P < 0.001). HR was significantly higher in the atropine group than in the control group during the study period.

Conclusions: This study demonstrated that the Time(EI)95 of a low dose of rocuronium (0.3 mg/kg) required for excellent tracheal intubation was 199 s during i.v. anesthesia induction using propofol and alfentanil in children. Also, i.v. atropine (10 μg/kg) before anesthesia induction was able to reduce Time(EI)95 by 28 s.

References

Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert P . Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology. 2003; 98(5):1049-56. DOI: 10.1097/00000542-200305000-00005. View

McAuliffe G, Bissonnette B, Cavalle-Garrido T, Boutin C . Heart rate and cardiac output after atropine in anaesthetised infants and children. Can J Anaesth. 1997; 44(2):154-9. DOI: 10.1007/BF03013003. View

Nava-Ocampo A, Velazquez-Armenta Y, Moyao-Garcia D, Salmeron J . Meta-analysis of the differences in the time to onset of action between rocuronium and vecuronium. Clin Exp Pharmacol Physiol. 2006; 33(1-2):125-30. DOI: 10.1111/j.1440-1681.2006.04338.x. View

Szmuk P, Ezri T, Chelly J, Katz J . The onset time of rocuronium is slowed by esmolol and accelerated by ephedrine. Anesth Analg. 2000; 90(5):1217-9. DOI: 10.1097/00000539-200005000-00041. View

Eikermann M, Hunkemoller I, Peine L, Armbruster W, Stegen B, Husing J . Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children. Br J Anaesth. 2002; 89(2):277-81. DOI: 10.1093/bja/aef177. View

Stoddart P, Mather S . Onset of neuromuscular blockade and intubating conditions one minute after the administration of rocuronium in children. Paediatr Anaesth. 1998; 8(1):37-40. DOI: 10.1046/j.1460-9592.1998.00719.x. View

Barclay K, Eggers K, Asai T . Low-dose rocuronium improves conditions for tracheal intubation after induction of anaesthesia with propofol and alfentanil. Br J Anaesth. 1997; 78(1):92-4. DOI: 10.1093/bja/78.1.92. View

Eikermann M, Renzing-Kohler K, Peters J . Probability of acceptable intubation conditions with low dose rocuronium during light sevoflurane anaesthesia in children. Acta Anaesthesiol Scand. 2001; 45(8):1036-41. DOI: 10.1034/j.1399-6576.2001.450819.x. View

Donati F . Onset of action of relaxants. Can J Anaesth. 1988; 35(3 ( Pt 2)):S52-8. DOI: 10.1007/BF03026928. View

10.

Viby-Mogensen J, Engbaek J, Eriksson L, Gramstad L, Jensen E, Jensen F . Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand. 1996; 40(1):59-74. DOI: 10.1111/j.1399-6576.1996.tb04389.x. View

11.

DIXON W . Staircase bioassay: the up-and-down method. Neurosci Biobehav Rev. 1991; 15(1):47-50. DOI: 10.1016/s0149-7634(05)80090-9. View

12.

Debaene B, Plaud B, Dilly M, Donati F . Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology. 2003; 98(5):1042-8. DOI: 10.1097/00000542-200305000-00004. View

13.

Takizawa E, Takizawa D, Al-Jahdari W, Miyazaki M, Nakamura K, Yamamoto K . Influence of atropine on the dose requirements of propofol in humans. Drug Metab Pharmacokinet. 2006; 21(5):384-8. DOI: 10.2133/dmpk.21.384. View

14.

Ezri T, Szmuk P, Warters R, Gebhard R, Pivalizza E, Katz J . Changes in onset time of rocuronium in patients pretreated with ephedrine and esmolol--the role of cardiac output. Acta Anaesthesiol Scand. 2003; 47(9):1067-72. DOI: 10.1034/j.1399-6576.2003.00218.x. View

15.

Tan C, Onisong M, Chiu W . The influence of induction technique on intubating conditions 1 min after rocuronium administration: a comparison of a propofol-ephedrine combination and propofol. Anaesthesia. 2002; 57(3):223-6. DOI: 10.1046/j.0003-2409.2001.02449.x. View

16.

Bartolek D, Jakobovic J, Bartolek F, Finci D, Munjiza A . Reduced-dose rocuronium for day-case tonsillectomy in children where volatile anaesthetics are not used: operating room time saving. Paediatr Anaesth. 2009; 20(1):47-55. DOI: 10.1111/j.1460-9592.2009.03175.x. View

17.

Oztekin S, Hepaguslar H, Kilercik H, Kar A, Boyaci F, Elar Z . Low doses of rocuronium during remifentanil-propofol-based anesthesia in children: comparison of intubating conditions. Paediatr Anaesth. 2004; 14(8):636-41. DOI: 10.1111/j.1460-9592.2004.01273.x. View

18.

Meretoja O . Neuromuscular block and current treatment strategies for its reversal in children. Paediatr Anaesth. 2010; 20(7):591-604. DOI: 10.1111/j.1460-9592.2010.03335.x. View

19.

Pace N, Stylianou M . Advances in and limitations of up-and-down methodology: a précis of clinical use, study design, and dose estimation in anesthesia research. Anesthesiology. 2007; 107(1):144-52. DOI: 10.1097/01.anes.0000267514.42592.2a. View

20.

Driessen J, Robertson E, van Egmond J, Booij L . Time-course of action of rocuronium 0.3 mg.kg-1 in children with and without endstage renal failure. Paediatr Anaesth. 2002; 12(6):507-10. DOI: 10.1046/j.1460-9592.2002.00891.x. View