Postoperative Neuromuscular Function in Pediatric Day-care Patients

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After anesthesia employing nondepolarizing muscle relax-ants, 30%–40% of adult patients demonstrate residual paralysis with a train-of-four ratio <70%, but it is not known if the same is true for children. This study was designed to investigate neuromuscular transmission in 91 ASA physical status I or II day-care children (aged 0–10 yr) after halothane anesthesia in which pancuronium (n = 34), atracurium (n = 32), or vecuronium (n = 25) was administered. Peripheral nerve stimulation was used clinically to assess neuromuscular blockade during surgery. In the recovery room, the evoked response of the adductor pollicis muscle was measured by train-of-four stimulation of the ulnar nerve. This measurement was made (mean ± SEM) at 28.0 ± 1.5, 15.0 ± 1.3, and 15.0 ± 1.7 min after pharmacologic antagonism with 0.02 mg/kg atropine and 0.06 mg/kg neostigmine in the pancuronium, atracurium, and vecuronium groups, respectively. There were no differences in the ages of the patients in the three groups at 4.3 ± 0.4, 4.0 ± 0.4, and 5.0 2 ± 0.5 yr, with 17 children less than 2 yr. Recovery from neuromuscular blockade in all three groups was almost complete. The train-of-four ratio (height of fourth twitch compared with the first) was similar in patients who had received pancuronium (96.7% ± 0.9%), atracurium (95.5% ± 0.9%), or vecuronium (96.3% ± 1.3%). Therefore, postoperative muscle weakness or respiratory impairment is unlikely in pediatric day-care surgical patients more than 2 yr old when these anesthetic techniques are used.

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