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Monitoring orbicularis oculi predicts good intubating conditions after vecuronium in children

1997; Springer Science+Business Media; Volume: 44; Issue: 7 Linguagem: Inglês

10.1007/bf03013383

1496-8975

Benoît Plaud, M. Laffon, Claude Ecoffey, Claude Meistelman,

Anesthesia and Pain Management

The aim of the study was to compare visual estimation of onset of neuromuscular blockade at both the adductor pollicis (AP) and the orbicularis oculi (OO) in children and to determine if monitonng the OO could predict good intubating conditions during vecuronium-induced neuromuscular blockade. Thirty ASA I–II children (1.5–9 yr) were studied. Anaesthesia was induced with 6–8 mg · kg−1 thiopentone. The ulnar nerve at the wrist and the temporal branch of the facial nerve were stimulated every 10 sec using train of-four (TOF) stimuli. Vecuronium. 0.15 mg · kg, was administered as a bolus. The responses at both the OO and the AP were evaluated visually. Patients were randomly divided into two groups. In the AP group (n = 15), the trachea was intubated when the AP was completely blocked. In the OO group (n = 15), intubation was performed when the OO was completely blocked. Intubating conditions were scored on a scale of 1 to 4. All the patients had complete blockade at both the orbicularis oculi and the adductor pollicis. In the two groups, time from injection of vecuronium to complete neuromuscular blockade was shorter at the orbicularis oculi than at the adductor pollicis, 1.5 ± 0.5 min vs 2.3 ± 0.7 min, respectively, (P < 0.05; mean ± SD) in the AP group, 1.7 ± 0.3 min vs 2.3 ± 0.8 min, respectively, in the OO group (P < 0.05). Intubating conditions were excellent in all patients except one. where it was rated as good. They did not differ between groups. Following administration of 0.15 mg · kg−1 vecuronium in children, monitoring of the OO can detect good intubating conditions 0.7 min earlier than with monitoring of the AP.