Increased cis-atracurium requirements during prolonged administration to a child

Abstract

Purpose: To report increased infusion requirements of cis-atracurium during prolonged infusion (six weeks) to provide neuromuscular blockade in a child during prolonged mechanical ventilation. Despite a previous study in adult patients which demonstrated no increase in infusion requirements over five days, we noted a considerable increase over six weeks. Clinical features: A seven month old infant required prolonged mechanical ventilation and neuromuscular blockade following an episode of multi-system organ failure from pseudomembranous colitis. The infusion of cis-atracurium was adjusted according to the train-of-four response obtained with a peripheral nerve stimulator using standard train-of-four monitoring. Initial infusion requirements which were 2.8 μg·kg-1 min-1 on day #1 increased to 22.3 μg·kg-1 min-1 on day #40. Conclusion: Increased infusion requirements were necessary during the prolonged administration of cis-atracurium to a critically ill infant. Titration of the dose based on monitoring with a peripheral nerve stimulator is recommended.