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British Journal of Anaesthesia, 2002, Vol. 89, No. 2 277-281
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children

M. Eikermann*, I. Hunkemöller, L. Peine, W. Armbruster, B. Stegen, J. Hüsing and J. Peters

Abteilung für Anästhesiologie und Intensivmedizin, Universität Essen, Hufelandstr. 55, D-45122 Essen, Germany*Corresponding author

Background. We studied 120 children aged 2–7 yr in a prospective, randomized, assessor-blinded fashion to define the optimal rocuronium dose which provides a 95% probability of acceptable intubation conditions (ED95TI) during inhalation induction with sevoflurane.

Methods. After inhalation induction with 8% sevoflurane in 60% nitrous oxide and 40% oxygen, and loss of the eyelash reflex, we administered rocuronium (0.1, 0.15, 0.22, 0.3, or 0.6 mg kg–1) or placebo. We quantified neuromuscular function by stimulation of the ulnar nerve at 0.1 Hz to produce contraction of the adductor pollicis muscle using accelerometry. Intubation conditions were assessed 2 min after test drug injection. The optimal rocuronium dose was defined as the lowest dose, which allowed acceptable intubation conditions in 95% of children (ED95TI).

Results. Two minutes after injection of placebo or rocuronium, intubation conditions were acceptable in 35, 45, 80, 90, 95, and 100% of children, respectively. Rocuronium 0.07 [CI 0.02–0.11], 0.24 [0.19–0.31], and 0.29 [0.23–0.38] mg kg–1 provided 50, 90, and 95% probability of acceptable intubating conditions. When thumb acceleration was depressed by 50% or more, intubating conditions were considered acceptable in 97% of children. Recovery of the train-of-four ratio to 0.8 averaged 12 (7), 16 (7), 24 (7), 24 (8), and 50 (22) min after the respective dose of rocuronium.

Conclusions. During inhalation induction with 8% sevoflurane in 60% nitrous oxide, rocuronium 0.29 mg kg–1 (ED95) optimizes intubation conditions for surgery of short duration.

Br J Anaesth 2002; 89: 277–81


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