SECTION ON CRITICAL CARE 1996 ANNUAL MEETING PROGRAM

Background: Some neuromuscular blocking agents have previously been shown to have clinically significant hemodynamic effects. These agents should obviously be avoided in patients whose hemodynamic status might be considered compromised. Rocuronium bromide (ROC) is a new steroidal non-depolarizing neuromuscular blocking agent recently approved for use by the FDA. The hemodynamic effects associated with its use in critically ill pediatric patients have not been reported. Methods: In a nonrandomized open-label study 10 infants and children (ages 1 mth to 68 mths, mean 14 mths; weight 2.9-16 kg, mean 6.3 kg) were given two doses of ROC (0.6 mg/kg followed by 0.9 mg/kg) as a neuromuscular blocking agent after congenital heart surgery, once their hemodynamic status was thought to be stable (mean 20 hours after admission). All patients were sedated with morphine, fentanyl, midazolam or a combination of fentanyl and midazolam. Hemodynamic parameters including heart rate (HR), blood pressure (BP), central venous pressure, left atrial pressure and pulmonary artery pressure were recorded when possible just prior to injection and at one minute, five minutes and ten minutes. Any apparent adverse effects were also noted. Results: ROC produced small, transient increases in HR and BP at both 0.6 and 0.9 mg/kg doses. For both doses, the peak increase in BP was noted at one minute, with BP returning to baseline by five minutes. The maximal mean increase in BP for either group at any time period was 6%. The maximal increase in mean BP in any patient was 22%. Peak HR response was noted at five minutes in both groups and HR did not return to baseline by 10 minutes.