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Canadian Journal of Anesthesia, Vol 33, 760-764, Copyright © 1986 by Canadian Anesthesiologists' Society

Neuromuscular Blockade For Rapid Tracheal Intubation in Children: Comparison of Succinylcholine and Pancuronium

MARY CUNLIFFE MB BS FFARCS1, V. MAXIM LUCERO MD1, M. ELIZABETH McLEOD MD FRCPC1, FREDERICK A. BURROWS MD FRCPC1, and JERROLD LERMAN MD FRCPC1

1 Department of Anaesthesia and the Research Institute, The Hospital for Sick Children, Toronto, Ontario

Address correspondence to: Dr. Jerrold Lerman, Department of Anaesthesia, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8.

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 1.0 mg·kg-1 (n = 13), pancuronium 0.15 mg·kg-1 (n = 11), or pancuronium 0.10 mg·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 mg·kg-1 (51.8 ± 14.0 seconds), slowest with pancuronium 0.10 mg·kg-1 (150.9 ± 38.0 seconds), 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 mg·kg-1, and pancuronium 0.15 mg·kg-1, but were excellent in only 69 per cent of those who received pancuronium 0.10 mg·kg-1. We conclude that succinylcholine 1.5 mg·kg-1 produces the most rapid onset of excellent intubating conditions in children. In children in whom succinylcholine is contraindicated, pancuronium 0.15 mg·kg-1 provides excellent intubating conditions within 80 seconds.

Key Words: ANAESTHESIA: paediatric • MEASUREMENT TECHNIQUES: neuromuscular blockade • NEUROMUSCULAR RELAXANTS: pancuronium, succinylcholine






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Copyright © 1986 by the Canadian Anesthesiologists' Society.