Continuous Infusion of Atracurium in Children

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Abstract
Atracurium infusion requirements were determined in 28 children anesthetized with N2O:O2 narcotic, N2O:O2 halothane (1% inspired), and N2O:O2 enflurane (2% inspired). When the patient was recovering from a bolus dose of 0.4 mg/kg atracurium, a continuous infusion of atracurium was started and the rate was adjusted to maintain 90-99% muscle twitch depression. Patients receiving enflurane anesthesia required atracurium at an infusion rate of 4.9 .+-. 0.3 .mu.g .cntdot. kg-1 .cntdot. min-1 which was a significantly lower rate (P = 0.0001) than those anesthetized with halothane (8.3 .+-. 0.4 .mu.g .cntdot. kg-1 .cntdot. min-1) or with N2O:O2 and narcotic (9.3 .+-. 0.5 .mu.g .cntdot. kg-1 .cntdot. min-1). At the onset of neuromuscular blockade, the twitch response disappeared faster after train-of-four stimulation repeated every 10 s than after single twitch rates of stimulation at 0.1 Hz. In children, during halothane anesthesia after 0.4 mg/kg atracurium, the response of the adductor of the thumb was ablated in 2.0 .+-. 0.3 min with train-of-four stimulation, and in 3.7 .+-. 0.4 min single twitch stimulation. The authors recommend the use of a nerve stimulator during continuous infusion of atracurium because of the marked interpatient differences in infusion-rate requirements.

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