Routine suxamethonium in children. A regional survey of current usage

This survey aimed to assess the extent and pattern of use of suxamethonium for elective tracheal intubation in children and the occurrence of major complications. A postal questionnaire was sent to 280 consultant anaesthetists and senior registrars in the West Midlands Region. Of the 180 replies received, 84% of respondents use suxamethonium routinely. Usage was more common amongst those more recently trained (all anaesthetists with less than 10 years experience reported using suxamethonium for routine intubation compared with 81% of those with over 20 years experience). Reported side effects directly attributable to suxamethonium were common, the most frequent being cardiac arrhythmias (especially bradycardia) following the first dose (24% respondents) or the second dose (43%), and prolonged apnoea (36% of respondents). There were 13 reported cardiac arrests (requiring external cardiac massage), three of which were associated with repeat dosing and one with undiagnosed Duchenne muscular dystrophy. Three cases of documented hyperkalaemia did not lead to cardiac arrest. There were two deaths, neither of which could be solely attributed to the use of suxamethonium. We conclude that suxamethonium remains popular in paediatric practice and that minor side effects are common and usually preventable. Life-threatening reactions are rare and until a truly comparable alternative is produced this drug will continue to be used in children.