Rapid-sequence endotracheal in tubation using high-dose vecuronium in children

ABSTRACT

Rapid-sequence endotracheal intubation is used to secure the airway in emergency surgical procedures. Succinylcholine is the standard muscle relaxant used for this purpose. However, its use is associated with numerous side effects. Vecuronium bromide was used in high doses, several times the ED95, to induce rapid-sequence intubation in children aiming at reaching a dose that has a short onset time of neuromuscular blockade and at the same time does not, unduly, prolong the duration of action or hinder reversibility by neostigmine. 40 ASA class 1 or 2 children were divided in 4 groups [n = 10] the first three groups received vecuronium in either 0.1, 0.15 or 0.2 mg/kg, while the forth received succinylcholine 1.5 mg/kg. Innervator NS252 was used to stimulate ulnar nerve while myograph 2000 was used to record thumb adduction. TOF at 10 sec. intervals was used to count onset time of neuromuscular blockade which was found to decrease from 103 +/- 35 to 58 +/- 15 seconds as vecuronium dose was increased. The last mean value +/- SD was shorter than onset time of succinylcholine 1.5 mg/kg [60 +/- 18 seconds] with absent significant difference between them [P >0.05]. DBS at 12 second intervals was used during recovery to determine duration of action, recovery index and reversal time. Duration of action was increased from 31 +/- 10 to 40 +/- 13 to 53.7 +/- 17 minutes as vecuronium dose was increased. The longest duration of action was with Vec0.2 mg/kg which was still within the scope of many surgical operations