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British Journal of Anaesthesia, 1988, Vol. 60, No. 6 651-654
© 1988 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

INFUSION OF ATRACURIUM IN NEONATES, INFANTS AND CHILDREN

A Study of Dose Requirements

I. KALLI* and O. A. MERETOJA

ILKKA KALLI, M.D.; OLLI A. MERETOJA, M.D.; Department of Anaesthesiology, Children's Hospital, University of Helsinki, Finland.

*Present address, for correspondence: Department of Anaesthesiology, Surgical Hospital, University of Helsinki, Kasarminkatu 11–13, SF-00130 Helsinki, Finland.

The doses of atracurium (by infusion) required to maintain steady-state (90–95%) neuromuscular block were assessed in 75 children aged 9 days to 17 yr during balanced anaesthesia. Following the intubating dose of atracurium 0.4 mg kg–1 and after the recovery of single twitch to 5–10% of control (monitored by evoked EMG of hypothenar muscle), an infusion of atracurium 0.5 mg kg–1 h–1 was started. In 22 of the patients this initial rate resulted in the desired steady state; 32 patients required one, and 21 required two or more adjustments in rate. The mean single twitch value at steady-state was 6.6±0.3% (SEM), which is equal to 93% neuromuscular block. The infusion requirement to maintain the steady state neuromuscular block in all paediatric patients more than 1 month old was constant (0.53±0.01 mg kg–1 h–1). The infusion requirement of neonates up to 1 month old was 25% less (0.40±0.02 mg kg–1 h–1; P = 0.003). A significant correlation (n = 75, r = 0.76, P < 0.001) was found between the infusion rate (mg m–2 h–1) and the logarithm of the body surface area.


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