INTUBATION IN CHILDREN AFTER 0.3 MG KG OF MIVACURIUM/

Study Objective: To distinguish among potential predictors of early, e asy intubation in children, including apnea, neuromuscular block at tw o sites, and time, after administration of 0.3 mg/kg of mivacurium. De sign: Prospective, randomized study. Setting: Operating rooms of Child ren's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. Patients: 60 A SA physical status I and II children aged 2 through 7 years, scheduled for elective surgical procedures requiring endotracheal intubation. I nterventions and Measurements: After premedication with midazolam, gen eral anesthesia was induced with halothane and nitrous oxide, and pati ents were randomly assigned to one of four groups. Mivacurium 0.3 mg/k g was given and tracheal intubation was begun 45 seconds after its inj ection, or when apnea, block of the orbicularis oculi, (OO) or block o f the adductor pollicis (AP) was noted. Intubation conditions conditio ns were evaluated by an experienced endoscopist. Main Results: The fir st clinical event after administration of mivacurium 0.3 mg/kg was apn ea at 43 seconds (median) average 48 seconds, SEM 2 seconds) after inj ection. The difference in the time at which neuromuscular block occurr ed at the AP (median 75 seconds) (average 77 seconds, SEM 2 seconds) a nd the OO (median 63 seconds) average 68 seconds, SEM 4 seconds) was s tatistically, but not clinically, significantly different. All nine in tubations that were begun at least 90 seconds after administration of mivacurium resulted in good or excellent intubation conditions, as did 30 of the 51 intubations started earlier. Conclusions: In children, t here is no advantage to monitoring neuromuscular function at the OO ra the than the AP. After administration of 0.3 mg/kg of mivacurium, a 90 -second interval before the start of intubation was a better predictor of good intubation conditions during halothane anesthesia (1% inspire d) than were changes in evoked neuromuscular function. (C) 1997 by Els evier Science Inc.