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Priming with rocuronium accelerates neuromuscular block in children: a prospective randomized study

[L’amorçage avec le rocuronium accélère le bloc neuromusculaire chez les enfants : une étude prospective randomisée]

Matthias Bock, MD DEAA^*, Lars Haselmann, MD, Bernd W. Böttiger, MD PhD and Johann Motsch, MD PhD

^* From the Department 1 of Anesthesiology, Bozen Central Hospital, Bozen, Italy; and the
Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany.

Address correspondence to: Dr. Matthias Bock, Department 1 of Anesthesiology, Bozen Central Hospital, Lorenz Böhler Strasse 5, I – 39100 Bozen, Italy. Phone: ++39 0471 908 673; Fax: ++39 0471 909 783; E-mail: matthias.bock{at}asbz.it

Purpose: To determine the effects of a priming technique with respect to onset time and duration of action of rocuronium (1.5 x ED₉₅, 2.0 x ED₉₅) in a pediatric patient population.

Methods: Eighty-four children, age one to seven years undergoing elective pediatric surgery, were studied in a randomized controlled trial. Neuromuscular function was assessed by accelerometry in response to single-twitch stimulation to assess onset of neuromuscular block, followed by train-of-four (TOF) stimulation at the wrist every 15 sec. Children were randomly allocated to one of four groups: Groups 1 and 3 received saline placebo, followed one minute later by a single bolus dose of rocuronium 0.45 mg·kg^–1 iv (1.5 x ED₉₅) and 0.6 mg kg^–1 iv (2.0 x ED₉₅), respectively. Patients in Groups 2 and 4 received an initial dose of rocuronium 0.045 mg·kg^–1 iv and 0.06 mg·kg^–1 iv, respectively, followed one minute later by rocuronium 0.405 mg·kg^–1 and 0.54 mg·kg^–1iv, respectively.

Results: Rocuronium priming significantly accelerated the time to maximum rocuronium-induced neuromuscular block when compared to placebo [median (95% confidence interval)]: 122.5 (98–186) vs 92.5 (68–116) sec (1.5 x ED₉₅, Group 1 vs Group 2, P < 0.05) and 85 (60–142) vs 55 (48–72) sec (2.0 x ED₉₅, Group 3 vs Group 4, P < 0.05), respectively. Spontaneous recovery to a TOF-ratio 0.9 was dose-dependent and not influenced by priming.

Conclusion: Priming accelerated the onset of rocuronium in children. A priming interval of one minute and a cumulative dose of rocuronium 1.5 x ED₉₅ resulted in an onset of neuromuscular block comparable to a single dose of rocuronium (2.0 x ED₉₅).

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