Atracurium infusion during paediatric craniofacial surgery. Closed loop control of neuromuscular block.

A simple feedback control system was used to administer atracurium to 10 infants aged between 5 and 36 months during craniofacial reconstruction. The purpose of the study was to establish whether the system, previously evaluated only in adults, would be effective in paediatric patients. The individuals studied underwent long procedures with substantial blood loss and the potential for thermal and electrolyte disturbances. The system maintained the level of neuromuscular block successfully between 88 and 100% in all patients and between 90 and 100% in nine patients. The mean duration of feedback control was 179 (range 111-440) minutes. The mean (SD) dose of atracurium required was 0.40 (0.12) mg/kg/hour. The mean (SD) recovery time to a train-of-four ratio of 0.75 was 24.8 (9.9) minutes.