• Matthias Bock, Lars Haselmann, Bernd W Böttiger, and Johann Motsch.
• Department 1 of Anesthesiology, Bozen Central Hospital, Bozen, Italy. matthias.bock@asbz.it
• Can J Anaesth. 2007 Jul 1;54(7):538-43.

PurposeTo determine the effects of a priming technique with respect to onset time and duration of action of rocuronium (1.5 x ED(95), 2.0 x ED(95)) in a pediatric patient population.MethodsEighty-four children, age one to seven years undergoing elective pediatric surgery, were studied in a randomized controlled trial. Neuromuscular function was assessed by accelerometry in response to single-twitch stimulation to assess onset of neuromuscular block, followed by train-of-four (TOF) stimulation at the wrist every 15 sec. Children were randomly allocated to one of four groups: Groups 1 and 3 received saline placebo, followed one minute later by a single bolus dose of rocuronium 0.45 mg.kg(-1) iv (1.5 x ED(95)) and 0.6 mg kg(-1) iv (2.0 x ED(95)), respectively. Patients in Groups 2 and 4 received an initial dose of rocuronium 0.045 mg.kg(-1) iv and 0.06 mg.kg(-1) iv, respectively, followed one minute later by rocuronium 0.405 mg.kg(-1) and 0.54 mg.kg(-1)iv, respectively.ResultsRocuronium priming significantly accelerated the time to maximum rocuronium-induced neuromuscular block when compared to placebo [median (95% confidence interval)]: 122.5 (98-186) vs 92.5 (68-116) sec (1.5 x ED(95), Group 1 vs Group 2, P < 0.05) and 85 (60-142) vs 55 (48-72) sec (2.0 x ED(95), Group 3 vs Group 4, P < 0.05), respectively. Spontaneous recovery to a TOF-ratio >or= 0.9 was dose-dependent and not influenced by priming.ConclusionPriming accelerated the onset of rocuronium in children. A priming interval of one minute and a cumulative dose of rocuronium 1.5 x ED(95) resulted in an onset of neuromuscular block comparable to a single dose of rocuronium (2.0 x ED(95)).

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