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Reduced-dose rocuronium for day-case tonsillectomy in children where volatile anaesthetics are not used: operating room time saving


Dubravka Bartolek, Department of Anaesthesiology and Intensive Care Unit, University Hospital of Traumatology, Kuhačeva 18, 10000 Zagreb, Croatia (email:


Objectives:  Mivacurium, rocuronium, and vecuronium are neuromuscular blocking agents (NMB) commonly used in pediatric day-case anesthesia. Mivacurium is the most appropriate NMB for short surgical procedures where NMB drugs were required but is not available in all countries.

Aim:  We evaluated the operating room time minimization after reduced-dose rocuronium (0.45 mg·kg−1) during elective day-case tonsillectomy in children.

Methods/Materials:  One hundred and five children (6–9 years, ASA I/II status) scheduled for day-case tonsillectomy were included in prospective, double blind clinical study. Children were randomly divided in three equal groups. All children were premedicated (midazolam 0.25 mg·kg−1 orally, EMLA). Anesthesia was induced (2.5 mg·kg−1) and maintained (0.1 mg·kg−1·min−2) by propofol and alfentanil (0.0015 mg·kg−1·min−1) and supplemented by inhalation mixture of 50% of O2/Air. Neuromuscular block was achieved by vecuronium (0.1 mg·kg−1) (V) or rocuronium in standard (0.6 mg·kg−1) (R) or reduced dose (0.45 mg·kg−1) (LD). Neuromuscular transmission was monitored by acceleromyography. Time analysis of NMB drugs action was performed.

Results:  Time difference from the end of tonsillectomy to T90 neuromuscular block recovery was significantly shorter in LD Group (7.3 ± 0.41 min), (V = 15.9 ± 1.06, R = 16.0 ± 1.7 min) (= 0.0011). The onset time of neuromuscular block was prolonged in LD Group (LD=3.1 ± 0.4, R = 1.3 ± 0.4, V = 2.2 ± 0.2 min) (= 0.0039) without changing the intubating conditions. The maximum operation room time saving per each tonsillectomy was 37% in LD Group (Group V 21%, Group R 17%) (= 0.0001). Low incidence of postoperative nausea and vomiting (PONV) 3–6% (0.4577) and good visual analog scale (VAS) score (≤2) (0.5969) were found in all study groups 12 h after surgery.

Conclusions:  Reduced-dose rocuronium in addition with propofol and alfentanil in children where volatile anesthetics are not used effectively saves the operating room time during short elective surgical procedures, avoids delays in patient recovery, allows high level of acceptable intubating conditions, and improves the optimal surgical work. Low incidences of PONV as VAS score may achieved successfully.

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