Use of low-dose rocuronium for intubation of children during volunteer surgery abroad

• Published in: Pediatric anesthesia 2005-08, Vol.15 (8), p.648-652
• Main Authors: POLITIS, GEORGE D., BRILL, JUDITH, JONES, JOHN
• Format: Article
• Language: English
• Subjects: Age Factors; Androstanols - administration & dosage; Anesthetics, Inhalation - administration & dosage; Blood Pressure - drug effects; Child; Child, Preschool; Halothane - administration & dosage; Heart Rate - drug effects; Humans; Infant; intratracheal intubation; Intubation, Intratracheal; Laryngismus - etiology; Laryngoscopy; medical missions; Medical Missions, Official; neuromuscular blockade; Neuromuscular Nondepolarizing Agents - administration & dosage; Oxygen - administration & dosage; Placebos; Respiration - drug effects; Respiration, Artificial; Safety; Surgical Procedures, Operative; Time Factors
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/j.1460-9592.2004.01519.x

Low-dose rocuronium (ROC) might improve safety during volunteer surgery abroad (VSA) by facilitating intubation with a lower halothane concentration than is typically used. We hypothesized that 0.25 mg.kg(-1) of ROC would improve intubation conditions during 3% halothane induction and still allow for rapid return to spontaneous ventilation (SV). During Operation Smile's 2002 mission to Honduras, patients aged 3 months-11 years were randomized to receive ROC 0.25 mg.kg(-1) (n = 19), or placebo (n = 23). Induction was with 3% halothane in 100% O(2), with ventilation assisted and controlled when possible, and normocarbia maintained. An i.v. was placed after induction, and ROC or placebo given. Direct laryngoscopy (DL) was performed 3 min later by a blinded laryngoscopist who assessed conditions according to predetermined criteria. Adequate intubation conditions occurred in 89 and 87% of patients (P = 0.59), and mean times from DL until the return to SV were 9.8 and 4.3 min (P = 0.003), in the ROC and placebo groups, respectively. For the placebo group, the presence of SV at DL was predictive of inadequate intubation conditions (P = 0.006). When administering 3% halothane for induction of VSA patients, a high frequency of adequate intubation conditions can be achieved without a relaxant, rendering the known benefits of 0.25 mg.kg(-1) of ROC unapparent. ROC 0.25 mg.kg(-1) does allow rapid return to SV.