Seza APİLİOĞULLARI, Selmin ÖKESLİ, Ruhiye REİSLİ, ATEŞ DUMAN, Öztin Cemile ÖĞÜN

Çocuklarda mivakuryum ve rokuronyumun nöromusküler blok ve entübasyon koşullarına etkisi

Amaç: Mivakuryum ve rokuronyumun sevofluran anestezisi altında adenotonsillektomi yapılacak çocuklarda nöromusküler bloğa ve entübasyon koşullarına etkilerini değerlendirmek amaçlandı. Yöntem: ASA I-II sınıfına giren, 2-12 yaş arasındaki 140 olgu Group M’de 0.2 mg/kg mivakuryum ve Group R’de 0.6 mg/kg rokuronyum uygulanmak üzere rasgele seçilmiş 2 gruba ayrıldı. Anestezi indüksiyonuna her iki grupta % 50 O2- % 50 N2O’den oluşan taze gaz akımına eklenen % 5 konsantrasyonda sevofluran ve 30 mcg/kg alfentanil ile başlandı. TOF-Guard ile T95, maksimal blok ve süresi, T25, T25-75, T70 parametreleri kaydedildi. Maksimal blok oluştuktan sonra entübe edilen ve entübasyon koşulları değerlendirilen hastalarda dekürarizasyon sadece rokuronyum grubunda uygulandı. Bulgular: T95 ve maksimal blok süresi Grup R'de istatistiksel olarak anlamlı derecede kısa iken grupların maksimal blok düzeyleri arasında anlamlı fark yoktu. T25 ve T70 süreleri Grup M'de, T25-75 süresi ise Grup R'de istatistiksel olarak anlamlı derecede kısa idi. Her iki grupta da mükemmel entübasyon koşulları saptandı. Sonuç: Her iki kas gevşeticinin de çocuklarda yeterli entübasyon koşullarını sağladığı, ancak rokuronyumun etki başlama süresinin kısa olması nedeniyle indüksiyonda ve acil durumlarda, mivakuryumun etki süresinin ve derlenme süresinin kısa olması nedeniyle kısa süreli operasyonlarda güvenle kullanılabileceği kanısına varıldı.

Anahtar Kelimeler:

Nöromüsküler blokaj, Tonsillektomi, Çocuk, okul öncesi, Çocuk, Adenoidektomi

Effects of nondepolarizing muscle relaxants mivacurium and rocuronium on neuromuscular blockade and intubation conditions in children

Objective: To evaluate intubation conditions and neuromuscular effects of mivacurium and rocuronium during sevofluran anesthesia in children, undergoing adenotoncillectomy. Methods: One hundred and forty healthy children, aged 2 to 12 years were randomized to 2 groups: 0.2 mg/kg mivacurium (Group M), 0.6 mg/kg rocuronium (Group R). Sevoflurane in 50% O2 and 50% N2O was used for induction of anaesthesia. 30 mcg/kg alfentanyl was applied intravenously. T95, maximal blockade and maximal blockade time, T25, T25-75, T70 parameters were recorded with TOF-Guard. The quality of endotracheal intubation was evaluated. Decurarization was omitted only in Group M. Results: The T95 time and maximal blockade time were significantly shorter in Group R. No significant difference was found in maximal blockades between the two groups. T25 and T70 times were significantly shorter in Group M, but T25-75 time was significantly shorter in Group R. Both mivacurium and rocuronium provied adequate intubation conditions. Conclusion: In children, having short duration of onset rocuronium is the agent to be preferred in induction and emergency states. Because of its short clinical effects and recovery time, mivacurium is the agent to be prefered in short duration operations.

Keywords:

Neuromuscular Blockade, Tonsillectomy, Child, Preschool, Child, Adenoidectomy,

PDF

___

1. Kayhan Z. Klinik Anestezi. 3.baskı. İstanbul: Logos; 2004. p.168.
2. Thwaites AJ, Edmends S, Tomlinson AA, Kendall JB, Smith I. Double-blind comparison of sevofluran vs propofol and succinylcholine for tracheal intubation in children. Br J Anaesth 1999; 83: 410-4.
3. Kayhan Z. Süksinilkolini hala kullanmalı mıyız? VII. kış sempozyumu özet kitabı 1998. p. 63-78.
4. Özceng D. Neuromuscular blockers. Türkiye Klinikleri J Anest Reanim 2005;3:116-30.
5. Szenohradszky J, Fisher DM, Segredo V, Caldwell JE, Bragg P, Sharma ML, et al. Pharmacokinetics of rocuronium bromide (Org 9426) in patients with normal renal function or patients undergoing cadaver renal transplantation. Anesthesiology 1992; 77:899-904.
6. Cooper R, Mirakhur RK, Clarke RSJ, Boules Z. Comparison of intubating conditions after administration of ORG 9426 and suxamethonium. Br J Anaest 1992;69:269.
7. Anon. Anaesthesia for tonsillectomy. Lancet 1987;13:1357-8.
8. Rosenberg H, Gronert GA. Intractable cardiac arrest in children given succinycholine. Anesthesiology 1992;77:1054.
9. Fisher DM. Neuromuscular blocking agents in paediatric anaesthesia. Br J Anaesth 1999;83:58-64.
10. Wappler F, Frings DP, Scholz J, Mann V, Koch C, Schulte am Esch J. Inhalational induction of anaesthesia with 8% sevoflurane in children: conditions for endotracheal intubation and side-effects. Eur J Anaesthesiol 2003; 20: 548-54.
11. Blair JM, Hill DA, Bali IM, Fee JP. Tracheal intubating conditions after induction with sevoflurane 8% in children. A comparison with two intravenous techniques. Anaesthesia 2000;55:774-8.
12. Larsen PB, Hansen EG, Jacobsen LS, Wiis J, Holst P, Rottensten H, et al. Intubation conditions after rocuronium or succinylcholine for rapid sequence induction with alfentanil and propofol in the emergency patient. Eur J Anaesthesiol 2005; 22: 748-53.
13. Sparr HJ, Giesinger S, Ulmer H, Hollenstein-Zacke M, Luger TJ. Influence of induction technique on intubating conditions after rocuronium in adults: Comparison with rapid-sequence induction using thiopentone and suxamethonium. Br J Anaesth 1996;77:339-42.
14. Hadimioglu N, Ertugrul F, Ertug Z, Yegin A, Karaguzel G, Erman M. The comparative effect of single dose mivacurium during sevoflurane or propofol anaesthesia in children. Paediatr Anaesth 2005;15:852-7.
15. Kaplan RF, Garcia M, Hannallah RS. Mivacurium induce neuromuscular blockade during sevoflurane and halothane anesthesia in children. Can J Anaesth 1995;42:16-20.
16. Shorten GD, Crawford MW, St Louis P. The neuromuscular effects of mivacurium chloride during propofol anesthesia in children. Anesth Analg 1996;82:1170-5.
17. Söğüt N, Memiş D, Alpaydın T, Pamukçu Z. Rokuronyum, mivakuryum ve cisatrakuryumun çocuklarda sinir kas kavşağına, entübasyon koşullarına ve hemodinamik parametreler üzerine etkilerinin karşılaştırılması. Türk Anest Rean Mecmuası 2000;28:29-32.
18. Ross AK, Dear GL, Dear RB, Margolis JO, Ginsberg B. Onset and recovery of neuromuscular blockade after two doses of rocuronium in children. B J Clin Anesth 1998;10:631-5.
19. Ribeiro FC, Scheiber G, Marichal A. Comparison of time course of neuromuscular blockade in young children following rocuronium and atracurium. Eur J Anaesthesiol 1998;15:310-3.
20. Suzuki T, Lien CA, Belmont MR, Tijan J, Savarese JJ. Edrophonium effectively antagonizes neuromuscular block at the laryngeal adductors induced by ropacuronium, rocuronium and cisatracurium, but not mivacurium. Can J Anaesth 2003;50:879-85.
21. Bartunek A, Gilly H, Huemer G, Yildiz S, Schramm W, Lackner FX, et al. Neostigmine and edrophonium. Antagonism of profound and shallow mivacurium blockade Anaesthesist 1997;46:96-100.
22. Naguib M, Abdulatif M, al-Ghamdi A, Hamo I, Nouheid R. Dose-response relationships for edrophonium and neostigmine antagonism of mivacurium-induced neuromuscular block. Br J Anaesth 1993;71:709-14.
23. Kendrick K. Prolonged paralysis related to mivacurium: A case study. J Perianesth Nurs 2005;20:7-12.
24. Eikermann M, Hunkemöller I, Peine L, Armbruster W, Stegen B, Hüsing J, et al. Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children. Brit Anaesthesia 2002; 89:277-81
25. Diefenbach C. Anestezi ve cerrahi girişim sırasında nöromusküler monitörizasyon. Çukurçeşme K. editör. Midilli K. Çeviri. 2.baskı İstanbul: Turgut; 1999.
26. Vuksanaj D, Fisher DM. Pharmacokinetics of rocuronium in children aged 4-11 years. Anesthesiology 1995;82:1104-10