The use of low doses of intermediate acting muscle relaxants in adenotonsillectomy

: In this study we compared the efficacy of a reduced dose of medium term neuromuscular blocking agents atracurium (0.20 mg/kg) and vecuronium (0.04 mg/kg) in short-term (8-10 min) pediatric surgery. Eighty-four children (ASA I and II) undergoing adenotonsillectomy were selected for this study. Their average age was 56 months (range 30-121 months). We compared intubation conditions and the level of neuromuscular blockade using accelerometry. The induction and maintenance of anesthesia were achieved by anaesthetic gas (halothane first followed by isoflurane). Later on 57 children received vecuronium 0.04 mg/kg (group V) and 27 atracurium 0.20 mg/kg (group A). The latency period was similar in both groups (114.5 +/- 36.1 sec gruppo V vs 100.1 +/- 32.1 sec gruppo A). Intubation was performed in the same period of time (159 +/- 17.4 sec gruppo V vs 156 +/- 20.8 sec gruppo A) and the stimulus was always less than 5% of the baseline values. Intubation was considered excellent in 93% of patients of group V, good in 3.5% and poor in 3.5%. Conversely in patients of group A intubation was considered excellent in 85%, good in 11.5% and poor in 3.5% (n.s.). The neuromuscular recovery, measured by T1 > 5%, was faster in group V (493.6 +/- 154.3 sec gruppo V) than group A (652.6 +/- 210.9 sec gruppo A) (p < 0.001). The TOF ratio during extubation was significantly lower in group A (0.556 +/- 0.177 gruppo A) than in patients of group V (0.789 +/- 0.173 gruppo V) (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)