Undernutrition in children - Effect on vecuronium induced neuromuscular blockade

Sixty children aged one to 12 years requiring anaesthesia including a muscl e relaxant were assessed for their nutritional status based on simple anthr opometric and biochemical parameters. They were allocated to one of four gr oups: normal nutrition, mild, moderate or severe malnutrition. The neuromuscular effects of vecuronium bromide 0.1 mg/kg were studied by r ecording evoked responses to train of four (TOF) nerve stimulation using an accelerograph. In the above nutritional groups, time to onset of 25% depre ssion of TI was 0.8, 1.4, 1.3 and 2.1 minutes respectively. Maximal depress ion of TOF response was seen at 2.2, 3.2, 3.7 and 8.4 minutes. The duration of action of the initial dose was 26.5, 24.0, 17.7 and 13.3 minutes and th e mean duration of action of top-up doses was 16.2, 14.9, 11.2 and 8.9 minu tes respectively Reversal time with neostigmine 0.05 mg/kg was not signific antly different in the four groups. These results demonstrate a statistical ly significant delay in onset and shortening of the duration of action of v ecuronium in the undernourished groups compared with the normal nutrition g roup when vecuronium is administered to children on a milligram per kilogra m basis.