engleski

Cost analysis of low-dose rocuronium for day-case tonsillectomy in children

Over the past few years there has been an increase of elective day-case tonsillectomy in children. Rocuronium and vecuronium are neuromuscular blockers used commonly in pediatric anesthesia. We evaluated the cost analysis following s low-dose rocuronium (0.45 mg/kg) as the intubating conditions, onset time, duration and spontaneous recovery of neuromuscular block in children for day-case tonsillectomy with mean duration under thirty minutes. Ninety children of ASA I or II status were studied in the prospective, randomized, double- blinded study. The Etic Committee of the Clinical Hospital Merkur approved protocol of the study. Anesthesia was induced with propofol 2.5 mg/kg. In thirty children muscle relaxation was achieved with vecuronium (0.1 mg/kg)(V)or rocuronium (0.6 mg(kg)) (R) in standard or in low-dose of rocuronium (0.45 mg/kg)(LR). Anesthesia was maintained by a continuous infusion of propofol (0.1 mg/kg min) and alfentanyl (0.0015 mg/kg min) with 50% oxygen in nitrous oxide. Neuromuscular transmission was monitored by means of acceleromyography with supramaximal train-of-four stimulation of the ulnar nerve with frequency of 1 Hz. A cost analysis was performed. Differences between three groups were evaluated by ANOVA and the Kruskal-Wallis test. Then a multiple linear regresion analysis was conducted. A P-value beloe 0.05 was considered as statistically significant. Multiple regression analysis revealed that intubating dose of vecuronium in standard dose for child (66 pounds) was on average cheaper per surgery than rocuronium (R=2.7, V=1.9 Euro. There was no significant difference in cost between low-dosis of rocuronium and vecuronium in standard dosis (LR=1.8, V=1.9 Euro). Although the onset time was significantly longer after a low-dose rocuronium (LR=3.1+/-0.4 ; R=1.3+/-0.4 ; V=2.2+/- min) no difference was found in the intubating conditions. Clinical duration of the block (T25) was significantly shorter after a low-dose rocuronium (LR=10.9+/- ; R=18.8+/-1.0 ; V22.7+/-4.1 min). Low-dose rocuronium in children was more economical for elective procedures in day-case tonsillectomy in children than standard dose. It results in a long onset time and shorter duration of the neuromuscular block without significantly changing intubating conditions.

rocuronium ; day case surgery ; tonsillectomy ; paediatric anaesthesia

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