Changes in Cisatracurium Infusion Requirements During Induced Hypothermia to Treat Increased Intracranial Pressure in a Child

Several factors may affect the dosing requirements of neuromuscular blocking agents in pediatric intensive care unit patients. I present a 4 year, 2 month old child who received neuromuscular blockade with cisatracurium and induced hypothermia to control increased intracranial pressure. Induction of hypothermia led to a reduction in cisatracurium infusion requirements. The infusion requirements promptly returned to baseline once the patient's body temperature was allowed to normalize. Priorto induction of hypothermia, the infusion requirements for cisatracurium averaged 3.2 μg/kg/min. During the 48 hours of deliberate hypothermia (core body temperature, 34°C) to control intracranial pressure, cisatracurium infusion requirements averaged 1.7 μg/kg/min. Infusion requirements promptly increased to 3.4 μg/kg/min once body temperature was allowed to return to normal.