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Succinylcholine pretreatment using gallamine or mivacurium during rapid sequence induction in children: a randomized,
M C Theroux1, J B Rose, S Iyengar
1Department of Anesthesiology and Critical Care Medicine, Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA. mtheroux@nemours.org
Journal of Clinical Anesthesia
|July 4, 2001
Summary
Mivacurium pretreatment effectively reduces succinylcholine-induced increases in serum potassium, myoglobin, and creatine phosphokinase (CPK) in children. This study highlights mivacurium
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
- Clinical Chemistry
Background:
- Succinylcholine is commonly used for rapid sequence induction (RSI) in pediatric anesthesia.
- RSI can lead to undesirable side effects such as fasciculations, myalgias, and elevations in serum potassium, myoglobin, and creatine phosphokinase (CPK).
- Pretreatment with neuromuscular blocking agents is sometimes employed to mitigate these effects.
Purpose of the Study:
- To evaluate the efficacy of gallamine or mivacurium as pretreatment agents before succinylcholine administration in pediatric patients.
- To assess the impact of these pretreatments on reducing fasciculations, postoperative myalgias, and serum levels of potassium, CPK, and myoglobin.
Main Methods:
- A prospective, randomized, double-blinded study was conducted in 45 pediatric patients (ASA physical status I, aged 3-15 years) undergoing emergency surgery.
- Patients received either normal saline, mivacurium (0.03 mg/kg), or gallamine (0.04 mg/kg) 2 minutes prior to RSI with thiopental, fentanyl, and succinylcholine.
- Serum potassium, myoglobin, and CPK levels were measured at various time points. Fasciculations and myalgias were scored.
Main Results:
- Mivacurium pretreatment significantly reduced the increase in serum potassium at 5 minutes, myoglobin at 5 and 15 minutes, and CPK at 24 hours compared to normal saline.
- No significant differences were observed in fasciculation or myalgia scores between the groups.
- Gallamine was not effective in reducing the measured biochemical markers, although a lower dose was used compared to mivacurium.
Conclusions:
- Mivacurium, when administered intravenously 2 minutes before succinylcholine in children, is effective in attenuating the acute rise in serum potassium, myoglobin, and CPK.
- This pretreatment strategy may help minimize the adverse biochemical effects associated with succinylcholine use in pediatric anesthesia.
- Gallamine did not demonstrate similar efficacy in this study at the tested dose.