Impact of rocuronium vs succinylcholine neuromuscular blocking drug choice for laparoscopic pyloromyotomy: is there a difference in time to transport to recovery?

Objectives/aim: This study evaluates the relationship between neuromuscular blocking drug administered and transport time following laparoscopic pyloromyotomy.

Background: Infants with pyloric stenosis have indication for rapid sequence induction. While succinylcholine has rapid onset and short duration, its use in children may be associated with rare serious adverse effects. Rocuronium is a widely accepted alternative, but its duration could contribute to delay at surgery end.

Methods: Infants undergoing laparoscopic pyloromyotomy at Loma Linda University Medical Center Children's Hospital from January 2006 to July 2011 were studied retrospectively. Only term infants receiving propofol induction, sevoflurane maintenance, no intraoperative opioid, and rocuronium, succinylcholine, or both were included. The primary outcome measure was time to transport after surgery stop as a measure of recovery from both anesthesia and relaxant. Data was analyzed for relationships between drug choice and time to transport.

Results:  Data from 246 patients was analyzed. Patients were similar in all groups. Time to transport was not affected by doses of propofol or neuromuscular blocking drug, anesthesia to surgery end interval or surgery length. Time to transport (minutes median, interquartile range) was 13 (7-21) in patients receiving only succinylcholine compared to 18 (11-24) in those receiving only rocuronium (P=0.03).

Conclusions: For laparoscopic pyloromyotomy in term infants using propofol, sevoflurane and no intraoperative opioid, succinylcholine may be the best neuromuscular blocking drug choice, provided no contraindication is present. However, based on the small difference in time to transport, rocuronium as administered herein may be a reasonable alternative preferred by some clinicians.