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Precurarisation in infants and children less than three years of age
Insights
Tubocurarine pretreatment significantly reduced muscle movements during anesthesia induction in young children. However, saline pretreatment led to increased creatine kinase (CK) levels in children over one year old, indicating muscle damage.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Succinylcholine is commonly used for muscle relaxation during pediatric anesthesia.
- Muscle fasciculations and potential for elevated creatine kinase (CK) levels are known side effects of succinylcholine.
- Pretreatment strategies are investigated to mitigate succinylcholine's adverse effects in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy of tubocurarine as a pretreatment to reduce succinylcholine-induced muscle movements in pediatric patients undergoing adenoidectomy or endoscopy.
- To assess the impact of tubocurarine and saline pretreatment on serum creatine kinase (CK) levels across different age groups.
Main Methods:
- A double-blind, randomized study involving 60 pediatric patients (<3 years) undergoing elective adenoidectomy or endoscopy.
- Patients were divided into three age groups (0-11, 12-23, 24-35 months).
- Pretreatment with either tubocurarine (0.05 mg/kg) or normal saline was administered before thiopentone induction, followed by succinylcholine (1.5 or 1.0 mg/kg). Muscle movements were graded, and serum CK levels were measured pre- and post-anesthesia.
Main Results:
- Tubocurarine pretreatment significantly reduced muscle movements across all age groups when compared to saline.
- Serum CK levels significantly increased in children over one year old pretreated with saline, but not in infants, despite observed muscle movements.
- No significant difference in CK levels was noted in the tubocurarine group.
Conclusions:
- Tubocurarine is an effective pretreatment for attenuating succinylcholine-induced muscle movements in pediatric anesthesia.
- Saline pretreatment may lead to elevated CK levels in older infants and toddlers, suggesting potential for muscle injury, while tubocurarine appears to mitigate this risk.
Abstract:
Sixty patients less than three years of age about to undergo adenoidectomy or endoscopy were divided into three groups of 20 each according to age (0-11 months, 12-23 months, 24-35 months). Before the induction of anaesthesia with thiopentone, either tubocurarine 0.05 mg X kg-1 or normal saline was given at random in a double-blind fashion. Three minutes later, the children received succinylcholine 1.5 or 1.0 mg X kg-1, respectively. Muscle movements were graded according to a four-point scale. Blood was sampled for creatine kinase (CK) activity before anaesthesia and on the following morning. When all age groups were combined, there was a significant reduction of muscle movements in patients who had received tubocurarine pretreatment. Serum CK activity rose significantly when saline pretreatment was used in children over the age of one year but not in the infants, despite the presence of muscle movements following succinylcholine administration.