Anesthésie et recherche clinique
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Abstrait

Selection of Optimal Muscle Relaxants for Small Surgical Interventions in Children

Nasibova Esmira Mirza

Aim: Comparative study of the action of the average action of muscle relaxants atrakurium besilata (tracrium), cisatracuria besilata and rocuronium bromide (esmerone) in small surgical interventions in children.

Materials and methods: The clinical trial included 156 patients aged from 0 to 16 years. All surgical interventions and manipulations were performed under balanced general anesthesia with the use of moderate-effect muscle relaxants: besilatum atracurium (tracrium), besilate cisatracuria and bromide rocuronium (esmerone). All patients studied (n=156) were divided into 3 main groups depending on the muscle relaxant used to create and maintain myoplegia during anesthesia: Ia group (n=52) as a muscle relaxant used rocuronium bromide, Ib group (n=52) atracurium besilate (tracrium) was used as a muscle relaxant, IC group (n=52)-cisatracuria besilate. To conduct a comparative assessment of the efficacy and safety of rocuronium bromide, atracuria, and cisatracuria besilat, neuromuscular conduction was monitored by the TOF method-stimulation ("traine of four") and performed using the TOF-Watch instrument (Organon Ireland).

Results: We have carried out a comparative assessment of the neuromuscular block with titrated doses of rocuronium bromide, atracuria of besylate and cisatracuria of besylate when combined with 1.3 MAC of isoflurane (subgroup " +iso " ) tracheal intubation, maintenance of general anesthesia and spontaneous restoration of neuromuscular conduction. The development of neuromuscular blockade with 90% suppression of T1 in children of the older age group with the highest rate occurred in the group with rocuronium bromide (Ia2), so the average values by the second minute were 22.5 ± 12.9% (0-14.0-37, 0), TOF -46.4 ± 19.7% (0-31.0-57.0), by the beginning of the 3rd minute from the moment of introduction they were -6.6 ± 1.8% (0-4, 0-12.0) with average values of TOF -28.2 ± 14.8 (0-5.0-100).

Conclusion: When using isoflurane, lower loading doses of besylate atracuria to 0.4 mg/kg, cisatracuria of besylate to 0.12 mg/kg and rocuronium bromide to 0.45 mg/kg ensure sufficient neuromuscular block depth (T1 suppression from 90% and higher). The time of onset of action in children under 1-year-old does not significantly change when using isoflurane. And in older children, significant differences were obtained only when comparing rocuronium bromide at doses of 0.45 mg/kg and 0.6 mg/kg (p<0.05).