Continuous infusion of rocuronium in a paediatric intensive care unit

Abstract

Purpose: To evaluate prospectively the efficacy and dose requirements of rocuronium administered by continuous infusion for neuromuscular blockade in a paediatric ICU population. Methods: Neuromuscular function was monitored by train-of-four (TOF) stimulation of the ulnar or peroneal nerve. Rocuronium was administered as a bolus dose (0.6 mg · kg-1) followed by a continuous infusion starting at 0.6 mg · kg-1 · hr-1. The infusion was increased or decreased by 0.1 mg · kg-1 · hr-1 to maintain one visible twitch of the TOF. All patients also received a benzodiazepine or a barbiturate infusion. Results: The study population included 20 patients (12 boys, eight girls) ranging in age from two months to 16 yr and in weight from 3.6 to 64 kg. The duration of the rocuronium infusion varied from 26 to 172 hr for a total of 1492 hr in the 20 patients. The rocuronium infusion requirements for day 1 varied from 0.3 to 0.8 mg · kg-1 · hr-1 (0.76 ± 0.3 mg · kg-1 · hr-1). When considering all patients and all patient days, the rocuronium infusion rate required to maintain one twitch of the TOF varied from 0.3 to 2.2 mg · kg-1 · hr-1 (mean for all patient days = 0.95 ± 0.4 mg · kg-1 · hr-1). The infusion requirements were 0.5 to 0.8 mg · kg-1 · hr-1 in 45 of the 64 patient days (70%) and 0.3 to 1.0 mg · kg-1 · hr-1 in 58 of the 64 patient days (90%). No problems with the infusion were noted. Conclusions: Continuous infusion of rocuronium can be used to provide neuromuscular blockade in the paediatric ICU patient. Due to the variability in infusion requirements, monitoring of neuromuscular function is suggested.