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Neuromuscular effects of rapacuronium in pediatric patients during nitrous oxide-halothane anesthesia: comparison with mivacurium

Barbara W. Brandom , MD^*, Judith O. Margolis , MD, George B. Bikhazi , MD, Allison K. Ross , MD, Brian Ginsberg, MD, Guy de L. Dear , MD, Charbel A. Kenaan , MD, John B. Eck , MD, Susan K. Woelfel, MD^* and Mark E. Lloyd , BS^*

^* From the Departments of Anesthesiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania (USA),
University of Miami/Jackson Memorial Hospital, Miami, Florida (USA), and
Duke University Medical Center, Durham, North Carolina (USA)

Barbara W. Brandom MD, Department of Anesthesiology, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213-2583 USA Phone: 412-692-5260; Fax: 412-692-8658; E-mail: bwb+{at}pitt.edu.

Purpose: To describe neuromuscular effects of rapacuronium in pediatric patients during N₂O-halothane anesthesia and compare them with mivacurium in children.

Methods: 103 pediatric patients, seven days - 12 yr, received rapacuronium or mivacurium during N₂O-halothane anesthesia. Onset and recovery of block were measured using EMG (Datex). Block was compared between groups based on drug treatment and age. Children < two years received 1 or 2 mgkg^–1 rapacuronium: 2 - 12 yr received either 2 mgkg^–1 or 3 mgkg^–1 rapacuronium, or 0.2 mgkg^–1 mivacurium.

Results: There were no differences in onset (1.7 ± 1.8 min) or maximum block (T1 2.4 ± 8%) among neonates, infants, and toddlers after either dose of rapacuronium. There was no difference between 1 and 2 mgkg^–1 of rapacuronium block at 60 sec. Train-of-four ratio (T4/T1) > 0.7 occurred later after 2 mgkg^–1 than 1 mgkg^–1 in these patients (P < 0.05). There was no difference in T25 among neonates, infants and toddlers for 1 mgkg^–1 or 2 mgkg^–1 doses. Rapacuronium, 3 mgkg^–1, produced maximum block 1.5 min earlier than did mivacurium, 0.2 mgkg^–1 (P < 0.001). There was no difference in block at 60 sec, maximum block or time to maximum block between 2 and 3 mgkg^–1 rapacuronium for children > two years of age. Maximum block occurred 1.0 ± 0.5 min after 2 or 3 mgkg^–1 when T1 was 0.2 ± 1.1% of baseline. T25 and T4/T1 > 0.7 occurred 10 to 11 min later after this dose of rapacuronium than after mivacurium.

Conclusion: Rapacuronium produces block earlier than mivacurium. Recovery from rapacuronium block is dose related and slower than that following mivacurium during halothane anesthesia.

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