Randomised controlled trial comparing cisatracurium and vecuronium infusions in a paediatric intensive care unit

Objective To evaluate and compare the efficacy, infusion rate and recovery profile of vecuronium and cisatracurium continuous infusion in critically ill children requiring mechanical ventilation.Design and setting Prospective, randomised, double-blind, single-centre study in critically ill children in a paediatric intensive care unit in a tertiary childrens hospital.Methods Thirty-seven children from 3 months to 16 years old (median 4.1 year) were randomised to receive either drug; those already receiving more than 6 h of neuromuscular blocking drugs were excluded. The Train-of-Four (TOF) Watch maintained neuromuscular blockade to at least one twitch in the TOF response. Recovery time was measured from cessation of infusion until spontaneous TOF ratio recovery of 70%.Results The cisatracurium infusion rate in nineteen children averaged 3.9±1.3 µg kg^–1 min^–1 with a median duration of 63 h (IQR 23–88). The vecuronium infusion rate in 18 children averaged mean 2.6±1.3 µg kg^–1 min^–1 with a median duration of 40 h (IQR 27–72). Median time to recovery was significantly shorter with cisatracurium (52 min, 35–73) than with vecuronium (123 min, 80–480). Prolonged recovery of neuromuscular function (>24 h) occurred in one child (6%) on vecuronium.Conclusions Recovery of neuromuscular function after discontinuation of neuromuscular blocking drug infusion in children is significantly faster with cisatracurium than vecuronium. Neuromuscular monitoring was not sufficient to eliminate prolonged recovery in children on vecuronium infusions.