A-1141
October 14, 2003
9:00:00 AM - 11:00:00 AM
The Moscone Center, Room Hall D
Anesthesiology, University Erlangen-Nuremberg, Erlangen, Germany.
Introduction: The administration of succinylcholine
in children with DMD is associated with specific, sometimes life-threatening
complications like rhabdomyolysis, hyperkalemia, or cardiac arrest. However,
there are conflicting results by case reports or reports with small numbers
about the sensitivity of these patients to non-depolarizing neuromuscular
blocking agents (NMBA)1,2. The aim of this study was to determine the
response of children with DMD to rocuronium, a known fast onset non-depolarizing
NMBA.
Methods: After approval of the local Ethics Committee and signed consent,
12 children undergoing orthopedic surgery of the spine were included. Following
preoxygenation anesthesia was induced with propofol (2-3mg/kg) and fentanyl 5-10
mcg/kg. Awaiting sufficient depth of anesthesia tracheal intubation was
performed without NMBA. Anesthesia was maintained with weight-adapted propofol
infusion, supplemented with remifentanil infusion to effect. The children`s
lungs were mechanically ventilated with a mixture of oxygen in air, minute
volume was adapted to an arterial CO2 of 35-40mmHg. After moving
patients in prone position, right arm was prepared for acceleromyographical
monitoring of neuromuscular blockade by stimulation of the ulnar nerve and
monitoring the adductor pollicis muscle, using TOF-watch SX monitoring system (Organon,
Germany). After calibration and signal stabilization rocuronium 0.6 mg/kg was
administered. Onset time (95% reeduction of twich response, T0), time of
recovery of first twitch response to 10% (T10%), 25% (T25%) and 90% (T90%),
recovery index (time between 25% and 75% recovery of first twitch, T25%-T75%),
and recovery time (time between 25% recovery of first twitch and recovery of TOF
ratio to 90%, T25%-TOF90%) were measured. All procedures were done with
reference to the Copenhagen Consensus Conference. Data are shown as mean ± SD.
Results: Children`s mean age was 13.3 ± 2.05 yrs, weight 49,8 ± 13.63
kg; height 157 ± 11 cm, and body mass index (BMI) 20.0 ± 3.73. Time course
data of response to rocuronium are presented in the table. In all children a
maximum effect of 100 % was achieved. Pharmakodynamic data showed high
interindividual differences, expressed by the high SD. Conclusions: We
present first pharmakodynamic data of rocuronium administered in children with
DMD. While recovery time was partially very long in these children indicating
increased sensitivity against rocuronium, the surprisingly found delayed onset
time apparently contradicts such an interpretation. Our data suggest that
children with DMD response different to rocuronium compared to children without
muscle disease.
References: 1Anesthesiology 1998;88::351-4, 2Anesth Analg
1999;89:340-1.
Anesthesiology 2003; 99: A1141
Time | T0 (Onset) | T10% | T25% | T90% | T25%-T75% | T25%-TOF90% |
Mean (min) | 4.17 | 62.55 | 76.27 | 129.41 | 36.70 | 73.21 |
± SD | 2.97 | 27.39 | 33.37 | 50.03 | 19.73 | 29.73 |