A prospective evaluation of the continuous infusion of cis-atracurium for neuromuscular blockade in the pediatric intensive care unit patient: efficacy and dosage requirements.

PURPOSE: To prospectively evaluate the efficacy and dosage requirements of cis-atracurium administered by continuous infusion for neuromuscular blockade in a pediatric intensive care unit population.
METHODS: Neuromuscular function was monitored by a train-of-four (TOF) over the ulnar or peroneal nerve. cis-Atracurium was administered as a bolus dose (0.2 mg/kg) followed by a continuous infusion starting at 3 microg/kg/min. The infusion was increased or decreased by 1 mIcrog/kg/min to maintain one twitch of the TOF. All patients also received a benzodiazepine infusion.
RESULTS: The study population included 15 children ranging in age from 10 months to 11 years and in weight from 4-28 kg. The duration of the infusion varied from 18-224 hours for a total of 1088 hours in the 15 patients. The cis-atracurium infusion requirements varied from 2.1 to 3.8 microg/kg/min (3.1 +/- 0.6) on day 1, to 1.4 to 6.4 microg/kg/min (3.4 +/- 1.4) on day 2, to 2.9 to 8.1 microg/kg/min (4. 5 +/- 1.6) on day 3. Overall, the infusion requirements varied from 1.4-22.7 microg/kg/min. The highest infusion requirements (22.7 and 10.2 microg/kg/min) were noted in patients who received cis-atracurium for prolonged periods of time (150 and 224 hours, respectively). The lowest infusion requirement occurred with the use of hypothermia to treat increased intracranial pressure.
CONCLUSIONS: cis-Atracurium can be used by continuous infusion to provide neuromuscular blockade in the pediatric intensive care unit patient. Because of the variability in infusion requirements, monitoring of neuromuscular function is suggested.