Korean J Anesthesiol.  2005 May;48(5):514-519. 10.4097/kjae.2005.48.5.514.

The Effect of Sodium Bicarbonate or Lidocaine Mixed with Rocuronium on Withdrawal Movement in Pediatric Patients

• Jung SM
• Kim SH
• Lim YS
• Kwon HU
• Kang PS
• Park CW

• KMID: 2238403
• DOI: http://doi.org/10.4097/kjae.2005.48.5.514

Abstract

BACKGROUND: Rocuronium administration after the induction of general anesthesia is associated with localized withdrawal of limbs or generalized movements in children and adolescents. The purpose of this study was to evaluate the effect of normal saline, lidocaine, sodium bicarbonate (NaHCO3), and lidocaine-NaHCO3 mixed with rocuronium reduces withdrawal response.
METHODS
Eighty-five pediatric patients (aged 5-15 years) were randomly assigned to one of four groups in a double blinded, prospective study; Group S (0.9% normal saline 5 ml mixed with rocuronium 50 mg/5 ml, n = 21), Group L (2% lidocaine 5 ml mixed with rocuronium 50 mg/5 ml, n = 22), group B (8.4% NaHCO3 5 ml mixed with rocuronium 50 mg/5 ml, n = 22) and Group LB (4% lidocaine 2.5 ml and 8.4% NaHCO3 2.5 ml mixed with rocuronium 50 mg/5 ml, n = 20). After loss of consciousness by sevoflurane inhalation, all patients received 0.6 mg/kg premixed rocuronium over 5 seconds. We investigated the incidence and severity of withdrawal movement using 4-point scales. We also measured pH values and the osmolalities of each mixture.
RESULTS
The incidence and degree of withdrawal reaction in response to rocuronium injection were significantly reduced in Groups B (18.1%) and LB (15.0%) versus Group S (57.1%). The addition of lidocaine failed to reduce withdrawal response compared with saline.
CONCLUSIONS
NaHCO3 mixed with rocuronium is more effective than lidocaine addition with suspect to preventing withdrawal movement in pediatric patients.

Keyword

lidocaine; pain; rocuronium; sodium bicarbonate; withdrawal movement

MeSH Terms

Adolescent
Anesthesia, General
Child
Extremities
Humans
Hydrogen-Ion Concentration
Incidence
Inhalation
Lidocaine*
Osmolar Concentration
Prospective Studies
Sodium Bicarbonate*
Sodium*
Unconsciousness
Weights and Measures
Lidocaine
Sodium
Sodium Bicarbonate