Incidence of residual neuromuscular blockade in children below 3 years after a single bolus of cisatracurium 0.1 mg/kg A quality assurance study

BACKGROUND: The aim of this quality assurance study was to determine the proportion of patients with residual block (train-of-four (TOF) ratio < 0.9) upon conclusion of surgery after a bolus of cisatracurium 0.1 mg/kg. It was considered good quality if less than 10% of the study population had residual block upon conclusion of surgery.

METHODS: A total of 40 patients ≤ 3 years of age scheduled for cleft lip and palate repair were consecutively enrolled. They received general anaesthesia with either sevoflurane and fentanyl (n=20) or propofol and remifentanil (n=20). TOF stimulation using acceleromyography was applied on the tibial nerve. Cisatracurium 0.1 mg/kg was administered to facilitate tracheal intubation.

RESULTS: Three patients (8 %; 95% CI: 1.7-21) had a TOF ratio < 0.9 at conclusion of surgery, all three receiving sevoflurane. In the sevoflurane group this corresponded to 16 % (95% CI: 3.3-40) of the patients. Mean duration of action of cisatracurium 0.1 mg/kg was 119 min (SD 40) with sevoflurane and 73 min (SD 29) during total intravenous anaesthesia (P < 0.001). Onset time of cisatracurium 0.1 mg/kg was 166 sec (SD 37) with sevoflurane and 199 sec (SD 60) during total intravenous anaesthesia.

CONCLUSION: We found that 8 % of the children had residual neuromuscular blockade (TOF ratio < 0.9) after administration of a single bolus of cisatracurium 0.1 mg/kg but we cannot exclude that the true proportion is around 20%.