BNF for Children 2011-2012

BNFC 2011–2012 15.1.5 Neuromuscular blocking drugs 645Side-effects see notes aboveLicensed use not licensed for use in children forassisted ventilation in intensive careIndication and doseTo avoid excessive dosage in obese children, doseshould be calculated on the basis of ideal weight forheightNeuromuscular blockade (intermediate duration)during surgery. By intravenous administrationChild 1 month–18 years initially by intravenousinjection 600 micrograms/kg, then either byintravenous injection, 150 micrograms/kgrepeated as required or by intravenous infusion,300–600 micrograms/kg/hour adjusted accordingto responseAssisted ventilation in intensive care. By intravenous administrationChild 1 month–18 years initially by intravenousinjection 600 micrograms/kg (optional), then byintravenous infusion, 300–600 micrograms/kg/hour for first hour, then adjusted according toresponseAdministration for continuous intravenous infusionor via drip tubing, may be diluted with Glucose 5% orSodium Chloride 0.9%Rocuronium (Non-proprietary) AInjection, rocuronium bromide 10 mg/mL, net price5-mL vial = £3.00, 10-mL vial = £6.00Esmeron c (Organon) AInjection, rocuronium bromide 10 mg/mL, net price5-mL vial = £2.90, 10-mL vial = £5.79VECURONIUM BROMIDECautions see notes aboveHepatic impairment caution in significant impairmentRenal impairment caution in renal failurePregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes aboveLicensed use not licensed for assisted ventilation inintensive careIndication and doseTo avoid excessive dosage in obese children, doseshould be calculated on the basis of ideal weight forheightNeuromuscular blockade (intermediate duration)during surgery. By intravenous administrationNeonate by intravenous injection initially80 micrograms/kg, then 30–50 micrograms/kgadjusted according to responseChild 1 month–18 years by intravenous injectioninitially 80–100 micrograms/kg, then either byintravenous injection, 20–30 micrograms/kgrepeated as required or by intravenous infusion,0.8–1.4 micrograms/kg/minute, adjusted accordingto responseAssisted ventilation in intensive care. By intravenous injectionNeonate initially 80 micrograms/kg, then 30–50 micrograms/kg adjusted according to response. By intravenous administrationNeonate by intravenous injection 80 micrograms/kg, then by intravenous infusion, 0.8–1.4 micrograms/kg/minute,adjusted according toresponse (risk of accumulation—consider interruptionof infusion)Child 1 month–18 years initially by intravenousinjection 80–100 micrograms/kg (optional), thenby intravenous infusion 0.8–1.4 micrograms/kg/minute, adjusted according to response; up to3 micrograms/kg/minute may be requiredAdministration reconstitute each vial with 5 mLWater for Injections to give 2 mg/mL solution; alternativelyreconstitute with up to 10 mL Glucose 5% orSodium Chloride 0.9% or Water for Injections—unsuitable for further dilution if not reconstituted withWater for Injections.For continuous intravenous infusion, dilute reconstitutedsolution to a concentration up to 40 micrograms/mLwith Glucose 5% or Sodium Chloride0.9%; reconstituted solution can also be given via driptubing.Neonatal intensive care, reconstitute each vial with5 mL Water for Injections to give a 2 mg/mL solution.Dilute 5 mg/kg body-weight to a final volume of50 mL with Glucose 5% or Sodium Chloride 0.9%; anintravenous infusion rate of 0.5 mL/hour provides adose of 50 micrograms/kg/hour; minimum concentrationof 40 micrograms/mLNorcuron c (Organon) AInjection, powder for reconstitution, vecuroniumbromide, net price 10-mg vial = £3.38 (with water forinjections)Depolarising neuromuscular blockingdrugsSuxamethonium has the most rapid onset of action ofany of the neuromuscular blocking drugs and is ideal iffast onset and brief duration of action are required e.g.with tracheal intubation. Neonates and young childrenare less sensitive to suxamethonium and a higher dosemay be required.Suxamethonium acts by mimicking acetylcholine at theneuromuscular junction but hydrolysis is much slowerthan for acetylcholine; depolarisation is therefore prolonged,resulting in neuromuscular blockade. Unlike thenon-depolarising neuromuscular blocking drugs, itsaction cannot be reversed and recovery is spontaneous;anticholinesterases such as neostigmine potentiate theneuromuscular block.Suxamethonium should be given after anaestheticinduction because paralysis is usually preceded by painfulmuscle fasciculations. Bradycardia may occur; premedicationwith atropine (section 15.1.3) reducesbradycardia as well as the excessive salivation associatedwith suxamethonium use.Prolonged paralysis may occur in dual block, whichoccurs with high or repeated doses of suxamethonium15 Anaesthesia