Abstract
To compare the effectiveness of succinylcholine and pancuronium for rapid intubation in children, 49 healthy children ages two to eight years were studied. After induction of anaesthesia with thiopentone and atropine, and administration of droperidol,fentanyl, nitrous oxide, and oxygen, each child received one of the following muscle relaxants: succinylcholine 1.5 mg.kg-1 (n = 12), succinylcholine 1.0mg.kg-1 (n = 13), pancuronium 0.15mg.kg-1 (n = 11), or pancuronium 0.10mg.kg-1 (n = 13). The force of thumb adduction was measured by stimulating the ulnar nerve with repetitive supramaximal single twitches (0.15 Hz). The time to 95 per cent twitch depression (mean ± S.D.) was most rapid with succinylcholine 1.5 mg.kg-1 (40.8 ± 3.0 seconds) and succinylcholine 1.0 mgkg-1(51.8 ± 14.0 seconds), slowest with pancuronium 0 .10 mg.kg-1 (150.9 ± 38.0seconds), and intermediate with pancuronium 0.15 mg.kg-1 (80.3 ± 21.8 seconds) (p < 0.005). The intubating conditions were excellent in 100% of the children who received succinylcholine 1.5 and 1.0 mgkg-1, and pancuronium 0.15 mg-kg-1, but were excellent in only 69 per cent of those who received pancuronium 0.10 mg.kg1. We conclude that succinylcholine 1.5 mg.kg1 produces the most rapid onset of excellent intubating conditions in children. In children in whom succinylcholine is contraindicated, pancuronium 0.15 mg.kg1 provides excellent intubating conditions within 80 seconds.
Résumé
Afin de comparer l’efficacité du succinylcholine et du pancuronium pour l’intubation rapide chez les enfants, 49 enfants en bonne santé âgés de deux à huit ans ont été édudiés. Après l’induction de Vanesthésie avec thiopen-tone et atropine, et l’administration de dropéridol, fentanyl, oxided’azote, eloxigène, chaque patient a reçu un des relaxants muscutaires suivants: succinylcholine 1.5 mg-kg-1 (n = 12), succinylcholine 1.0 mg.kg-1 (n = 13), pancuronium 0.15 mg.kg1 (n = 11), ou pancuronium 0.10mg.kg1 (n = 13). La forcede l’adduction du pouce a été mesurée par la stimulation du nerf cubital avec des twitches uniques répétitives et supramaximales (0.15 Hz). Le temps nécessaire pour avoir une dépression à 95 pour cent du twitch (moyenne ± SD) a été le plus rapide avec la succinylcholine 1.5 mg.kg-1 (40.8 ±3.0 secondes) et la succinylcholine 1.0 mg.kg-1 (51.8 ± 14.0 secondes), le plus lent étant avec le pancuronium 0.10 mg.kg-1 (150.9 ± 38.0 secondes), et étant intermédiaire avec du pancuronium O.15 mg.kg-1 (80.3 ± 21.8 secondes) (p < 0.005). Les conditions d’intubation étaient excellentes chez 100 pour cent des enfants ayant reçu la succinylcholine 1.5 à 1.0mg.kg-1 et du pancuronium 0.15mg.kg-1 mais étaient excellentes chez seulement 69 pour cent de ceux qui ont reçu du pancuronium 0.10mg.kg-1. On conclue que la succinylcholine 1.5mg.kg-1 produit le relâchement musculaire le plus rapide pour des conditions d’intubation excellentes chez les enfants. Pour les enfants où la succinylcholine est contre-indiquée, le pancuronium 0.15 mg.kg-1fournit d’excellentes conditions d’intubation en dedans de 80 secondes.
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Cunliffe, M., Lucero, V.M., McLeod, M.E. et al. Neuromuscular blockade for rapid tracheal intubation in children: comparison of succinylcholine and pancuronium. Can Anaesth Soc J 33, 760–764 (1986). https://doi.org/10.1007/BF03027127
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DOI: https://doi.org/10.1007/BF03027127