Issn Print: 0265-0215

Publication Date: 1997/09/01


Print

Continuous infusion of atracurium in ARDS patients: 15

J.-Y. Lefrant; G. Aya; P. Cuvillon; G. Saïssi; J.-E. de La Coussaye; J.-J. Eledjam

    loading  Checking for direct PDF access through Ovid

Excerpt

Introduction: Muscle relaxants associated with sedation are widely used to allow mechanical ventilation in patients with Adult Respiratory Distress Syndrome (ARDS) [1,2]. Atracurium has not been studied with regard to the effectiveness of muscle paralysis and the timing of spontaneous neuromuscular recovery. The aims of the study were to describe the effectiveness of, and the recovery from, neuromuscular blockade produced by atracurium given as a constant infusion.
Methods: Since May 1996, consecutive mechanically ventilated patients with ARDS were included [3]. Patients were sedated (flunitrazepam: 1 mg h−1, fentanyl 250 μg h−1). Exclusion criteria were: patients < 18, pregnancy, known sensitivity to muscle relaxants, history of malignant hyperthermia or of seizures, neuromuscular disease, administration of a muscle relaxant during the previous 24 h. Neuromuscular monitoring was quanitified with an accelerograph (TOF-Guard®) at the adductor pollicis muscle. A bolus of 1 mg kg−1 of atracurium was given over 3 min followed by a constant infusion (1 mg kg−1 h−1) for 72 h [3]. TOF count, TOF ratio (T4/T1) ana post-tetanic count stimulation (PTC) were recorded at baseline and 5T min, 60 min, 24, 48, 72 h after bolus. After the cessation of infusion, they were recorded at 5, 10, 15, 20, 30, 60 and 90 min. The time to neuromuscular recovery (T4/T1 ≥70%) was also measured.
Results: Nine patients (seven males, two females, 41-73 years old) were included. APACHE II ranged from 8 to 19. PaO2/FiO2 ratio ranged from 70 to 130 mmHg. The evolution of TOF count is shown in Fig. 1. When TOF count was 0, PTC was recorded from 1 to 7. Recovery from neuromuscular blockade occurred at 37 to 71 min (median value = 55 min) after the cessation of infusion.
Conclusion: This regimen of administration of atracurium provided effective neuromuscular blockade during the infusion and was quickly reversed after the cessation of infusion.
    loading  Loading Related Articles