Akademik Veri Yönetim Sistemi
Annual Congress of the European Society for Paediatric Anaesthesiology , Avila, İspanya, 22 - 24 Eylül 2011, ss.42-43
Muscle relaxant drugs which enabled muscle relaxation -one of the most important
cornerstones of anesthesia- to be performed routinely in practice of anesthesiology,
become one of the main components of this practice. Muscle relaxants are used in
pediatric anesthesia as well as adult anesthesia to obtain adequate muscle relaxation for
intubation and operation. The aim of this study is to compare the effects of 2 different
muscle relaxants on neuromuscular block, intubation quality and recovery.
Method:
After approval of local ethics committee, 2 randomized groups were constituted with ASA
I, 60 cases aged between 1-
Hospital Pediatric Surgery Clinics for elective lower abdominal and urogenital surgery.
Starting with maximal block, the stages of recovery from the effects of muscle relaxant
was examined by TOF follow-up with 12 second intervals. The times to reach maximal
blockade (seconds)(TOF0), 25% (TOF25) and 75% (TOF75) of TOF value after maximal
block were recorded by using TOF Watch SX (Organon Technica) .“SPSS for Windows 13.0”
statistical package program was used to evaluate the data. Comparisons were made by
using Student’s t test and Chi-square test.
Results and Discussion
In our study it was observed that, TOF 0, TOF 25 and TOF 75 times were 87.38 ± 20.93 sec,
24.48 ± 6.41 min, and 38.77 ± 8.24 min, respectively in Rocuronium group, whereas they
were 119.30 ± 23.32 sec, 33.13 ± 4.13 min, and 51.37 ± 1.95 min in Atracurium group.
Rocuronium resulted in statistically significantly shorter times in all TOF values with
respect to atracurium. There were no statistically significant differences between the
groups in terms of operation time, doses of other used drugs, and quality of intubation.
Comparison of drug-induced complications between the groups showed that allergy and
bronchospasm complications were seen in 4 patients of atracurium group whereas the
patients in rocuronium group showed no complications. This difference was statistically
significant. It is aimed to choose the better neuromuscular blocker with rapid action which
leads to sufficient muscle relaxation during operation and also leads to rapid and safe
recovery. These neuromuscular blockers may show different pharmacokinetics and
pharmacodynamics in children with regard to adults. Therefore, additional aim was to
avoid of excess doses and different administrations. Muscle relaxant agents are
distributed in extracellular space and they constitute lower plasma concentrations in
EUROPEAN SOCIETY FOR PAEDIATRIC ANAESTHESIOLOGY 43
Abstracts of poster presentations, Palma de Mallorca 43
children when compared to adults. Therefore, to reach a similar neuromuscular block
level in children, a higher muscle relaxant dose may be needed.(1) It is stated that
neuromuscular blockers lead to a faster recovery period in pediatric patients when
compared to adults. Possible reason of this may be the more rapid distribution of the drug
in affected areas due to higher cardiac output per kilogram of body weight in children.(2)
Conclusions : In this study, we evaluated pediatric outpatients underwent lower
abdominal surgery or urogenital surgery. In our hospital, pediatric surgery operations
especially lower abdominal and urogenital interventions mostly last shorter than 1 hour.
Most of the patients are discharged from hospital in the evening of the operation day.
It is concluded that in short-duration operations of outpatient pediatric surgery
cases such as patients of our study, rocuronium may be used safely due to its short
recovery period, rapid start of action, and lower rate of allergic reaction development.