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Submental administration of succinylcholine in children
R J Redden1, M Miller, R L Campbell
1Medical College of Virginia, Richmond.
Insights
Succinylcholine administered via an intralingual submental injection effectively treated pediatric laryngospasm. Digital massage of the injection site significantly improved success rates and reduced onset time for this emergency treatment.
Area of Science:
- Pediatric Anesthesiology
- Emergency Medicine
Background:
- Laryngospasm is a risk during pediatric inhalation induction before IV access.
- Intramuscular succinylcholine is a common treatment for laryngospasm.
Purpose of the Study:
- To compare the efficacy of submental intralingual succinylcholine injection versus traditional intramuscular sites for treating pediatric laryngospasm.
- To evaluate the impact of digital massage on submental injection effectiveness.
Main Methods:
- Fifteen pediatric patients received intramuscular succinylcholine (3.0 mg/kg) via submental intralingual or quadriceps femoris injection after halothane/nitrous oxide induction.
- Electromyography measured time to 90% twitch depression.
- A subgroup received digital massage at the submental injection site.
Main Results:
- Submental intralingual injection showed a mean twitch depression time of 265 +/- 62.5 seconds.
- Quadriceps femoris injection had a mean depression time of 295 +/- 42.6 seconds.
- Digital massage of the submental site resulted in a mean depression time of 133 +/- 11.9 seconds with a 100% success rate.
Conclusions:
- Submental intralingual succinylcholine injection is a viable alternative for treating pediatric laryngospasm.
- Digital massage significantly enhances the speed and success of submental succinylcholine administration.
Abstract:
During inhalation induction of the pediatric patient, laryngospasm can develop before intravenous access has been established. The intramuscular administration of succinylcholine is commonly used in such instances. This study was designed to determine if the injection of succinylcholine by an extraoral submental approach would be an acceptable method of terminating laryngospasm when compared to conventional intramuscular sites. Following induction with halothane and nitrous oxide in oxygen, a total of fifteen ASA 1 children were given 3.0 mg/kg intramuscular succinylcholine either intralingually by a submental approach, or using the upper leg musculature in order to electromyographically measure the time to maximum (or 90 percent depression from baseline) twitch depression. The intralingual submental injection had a mean twitch depression of 265 +/- 62.5 seconds compared to the quadriceps femoris at 295 +/- 42.6 seconds. A group with digital massage of the intralingual injection site produced a mean depression time of 133 +/- 11.9 seconds and was also the only group providing 100% success rate in reaching the desired twitch depression level. This may suggest that the operator should consider digital massage to produce a more predictable and desirable result.