Succinylcholine pretreatment using gallamine or mivacurium during rapid sequence induction in children: a randomized, controlled study

• Published in: Journal of clinical anesthesia Vol. 13; no. 4; pp. 287 - 292
• Main Authors: Theroux, Mary C, Rose, John B, Iyengar, Shuba, Katz, Michael S
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2001; Elsevier Science
• Subjects: Adolescent; Anesthesia; Biological and medical sciences; Child; Child, Preschool; Creatine Kinase - blood; Creatinine phosphokinase; Double-Blind Method; Drug toxicity and drugs side effects treatment; Emergency Medical Services; fasciculation; Female; Gallamine Triethiodide; Humans; hyperkalemia; Isoquinolines; Male; Medical sciences; Myoglobin - metabolism; myoglobinemia; Neuromuscular Depolarizing Agents; Neuromuscular Nondepolarizing Agents; Pain, Postoperative - epidemiology; pediatrics; Pharmacology. Drug treatments; Potassium - blood; pretreatment; Prospective Studies; Succinylcholine; Toxicity: nervous system and muscle; Creatinine phosphokinase; myoglobinemia; pretreatment; fasciculation; hyperkalemia; pediatrics; Hydroelectrolytic balance disorder; Toxicity; Suxamethonium chloride; Inorganic element; Depolarisant myorelaxant; Alkaloid; Rapid technique; Pain; Child; Neuromuscular blocking; Myoglobinuria; Human; Urine; Isoquinoline derivatives; Induction; Fasciculation; Gallamine triethiodide; General anesthesia; Myalgia; Hyperkaliemia; Striated muscle disease; Metabolic disorder; Non depolarisant myorelaxant; Mivacurium chloride; Premedication
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/S0952-8180(01)00267-7

Study Objective: To determine if pretreatment with either gallamine or mivacurium before succinylcholine in children is associated with reduction in fasciculations; postoperative myalgias; or serum levels of potassium, creatinine phosphokinase (CPK), and myoglobin. Design: Prospective, randomized, double-blinded study. Setting: Operating room at a children’s hospital. Patients: 45 ASA physical status IE children, aged 3 to 15 years, scheduled for emergency surgery. Interventions: The children received either normal saline 0.5 mL, mivacurium chloride 0.03 mg · kg -1 , or gallamine triethiodide 0.04 mg · kg -12 minutes prior to rapid sequence induction (RSI) using thiopental sodium 5 mg · kg -1, fentanyl 2 μg · kg -1 , and succinylcholine 2 mg · kg -1. Measurements: Serum potassium concentration (0, 3, 5, 7.5, and 15 min), myoglobin concentration (5 and 15 min), and CPK concentration (0 min and 24 hr). Fasciculation and myalgia were rated on a 0 to 3 score. Main Results: There was no difference between groups for fasciculation (p = 0.87) or myalgia score (p = 0.52). The mivacurium group had significantly less increase in potassium at 5 minutes (0.45 vs. 0.0, p = 0.01), myoglobin at 5 minutes (56 vs . 2, p < 0.001), myoglobin at 15 minutes (128 vs . 2.5, p < 0.001), and CPK at 24 hours (399 vs . 138, p < 0.001) following succinylcholine when compared with normal saline. Additionally, we found a significant level of association (p < 0.001) between fasciculation and myoglobin levels and fasciculation and CPK levels (p < 0.001). Gallamine was not effective in reducing the increase of potassium, myoglobin, or CPK. However, the dose of gallamine used for pretreatment was 13 times less than the dose of mivacurium. Conclusions: Administration of mivacurium 0.03 mg · kg -1 intravenously 2 minutes before administration of succinylcholine 2 mg · kg -1 in children is effective in reducing the increase in serum potassium at 5 minutes, the increase in myoglobin at 5 minutes and 15 minutes, and the increase in CPK at 24 hours.