RECOVERY FROM DOXACURIUM INFUSION ADMINISTERED TO PRODUCE IMMOBILITY FOR MORE THAN 4 DAYS IN PEDIATRIC-PATIENTS IN THE INTENSIVE-CARE UNIT

Doxacurium was administered by titrated infusion to 14 pediatric patie nts for 4.7-12.3 days after laryngotracheal reconstruction to produce minimum spontaneous movement and less than five posttetanic movements of the first toe after stimulation of the posterior tibial nerve. Reco very was documented by stimulation of the ulnar nerve with 2 Hz for 2 s (train-of-four [TOF]) at intervals of 1 min and measurement of the r atio of the fourth to the first response (TOF ratio) at the adductor p ollicis. During spontaneous recovery, the TOF ratio was between 0.4 an d 0.7 for 0.6-3.3 h, mean (SEM) 2.2 (0.31) h. The TOF ratio equaled 1 between 4.7 and 23.0 h, mean (SEM) 11.0 (2.1) h after termination of d oxacurium infusion. In six of the patients, weakness and decreased coo rdination were noted for a few days to weeks postoperatively. There we re no complications related to impairment of upper airway function or ventilation in those patients who had recovery of neuromuscular transm ission to the extent of TOF ratio equal to 1 prior to extubation or in those patients in whom weakness or lack of coordination was noted aft er tracheal extubation.