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Changes in heart rate and rhythm after intramuscular succinylcholine with or without atropine in anesthetized

R S Hannallah, T H Oh, W A McGill

    Anesthesia and Analgesia
    |December 1, 1986
    PubMed

    Insights

    Intramuscular succinylcholine, with or without atropine, is safe for young children undergoing light anesthesia. This study found no severe bradycardia, indicating its potential use in pediatric anesthesia.

    Area of Science:

    • Pediatric Anesthesiology
    • Pharmacology
    • Cardiovascular Physiology

    Background:

    • Intramuscular drug administration is an alternative route for pediatric anesthesia.
    • Succinylcholine is a common neuromuscular blocking agent, but its effects on heart rate require careful consideration, especially in children.
    • Atropine is often used to counteract bradycardia associated with certain anesthetic agents or neuromuscular blockers.

    Purpose of the Study:

    • To investigate the effects of intramuscular succinylcholine, with or without atropine, on heart rate and rhythm in young children.
    • To determine the safety and efficacy of this administration route for succinylcholine in pediatric anesthesia.
    • To compare the cardiovascular effects of different doses of atropine when combined with succinylcholine.

    Main Methods:

    • Fifty unpremedicated children aged 6-18 months received anesthesia induced with nitrous oxide-oxygen and halothane.
    • Study drugs (succinylcholine, atropine, or combinations) were administered intramuscularly 60 seconds after induction.
    • Heart rate and rhythm were monitored throughout the procedure, with comparisons made between groups and a control group.

    Main Results:

    • Intramuscular succinylcholine (4 mg/kg) with or without atropine (0.02 mg/kg) caused transient increases in heart rate, followed by decreases, but not severe bradycardia.
    • A higher dose of atropine (0.03 mg/kg) with succinylcholine resulted in a prolonged secondary increase in heart rate.
    • Control patients experienced a decrease in heart rate after anesthetic induction.

    Conclusions:

    • Intramuscular succinylcholine at 4 mg/kg can be safely administered to lightly anesthetized young children, with or without atropine (0.02 mg/kg), without causing significant bradycardia.
    • This route of administration offers a viable option for neuromuscular blockade in pediatric patients.
    • The findings support the use of intramuscular succinylcholine in specific pediatric anesthesia scenarios.

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