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Canadian Journal of Anesthesia, Vol 44, 82-84, Copyright © 1997 by Canadian Anesthesiologists' Society

ARTICLES

Increased cis-atracurium requirements during prolonged administration to a child

JD Tobias
Department of Child Health, University of Missouri, Columbia 65212, USA.

PURPOSE: To report increase infusion requirements of cis-atracurium during prolonged infusion (six weeks) to provide neuromuscular blockade in a child during prolonged mechanical ventilation. Despite a previous study in adult patients which demonstrated no increase in infusion requirements over five days, we noted a considerable increase over six weeks. CLINICAL FEATURES: A seven month old infant required prolonged mechanical ventilation and neuromuscular blockade following an episode of multi-system organ failure from pseudomembranous colitis. The infusion of cis-atracurium was adjusted according to the train-of-four response obtained with a peripheral nerve stimulator using standard train-of-four monitoring. Initial infusion requirements which were 2.8 micrograms.kg-1 min-1 on day #1 increased to 22.3 micrograms.kg-1 min-1 on day #40. CONCLUSION: Increased infusion requirements were necessary during the prolonged administration of cis-atracurium to a critically ill infant. Titration of the dose based on monitoring with a peripheral nerve stimulator is recommended.




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Copyright © 1997 by the Canadian Anesthesiologists' Society.