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Canadian Journal of Anesthesia, Vol 9, 293-305, Copyright © 1962 by Canadian Anesthesiologists' Society

The Muscle Relaxants in Infants and Children

T. J. McCAUGHEY M.B., B.CH., D.A.1

1 Anaesthetist-in-Chief, The Children's Hospital, and Assistant Professor of Surgery (Anaesthesia), University of Manitoba, Winnipeg, Manitoba

Many anaesthetists have been reluctant to apply the use of muscle relaxants to anaesthesia for infants and children. Endotracheal intubation, controlled respiration, and muscle relaxation are facilitated by the use of these drugs to the advantage of both patient and surgeon, in infants and children as much as in adults.

Succinylcholine is used a great deal in anaesthesia at the Children's Hospital, Winnipeg. If a technique of careful oxygenation is carried out, it has been shown to be quite safe for unhurried intubation even in the new-born. Investigation has revealed that the effective dose for both intubation and control of respiration is far less than is commonly taught and that the new-born is not as markedly resistant to succinylcholine as many have said. The use of intravenous infusions of 0.1 per cent and 0.2 per cent succinylcholine is a common cause of overdosage and is seldom employed at this hospital even for large children.

The effects of succinylcholine on the cardiovascular system are complicated. The braycardia that occurs may require large intravenous doses of atropine to abolish it. These arrhythmias are apparently not dangerous in most cases. In chronic burns, however, the drug has a sinister reputation and is best avoided at the present time.

Gallamine triethiodide is the drug commonly employed for longer-acting muscle relaxation Tachycardia caused by this drug may be useful in strabismus surgery.

Obstruction of the airway, congenital glaucoma, surgery for cataracts and penetrating eye injuries contraindicate succinylcholine, while hypothermia prolongs its action. Infancy, myasthenic-like states, and diminished respiratory function contraindicate curare-like drugs.

The use of the curare sensitivity test to diagnose myasthenic-like states and the diminishing importance of relaxants in treating tetanus are mentioned.

Note:

Presented at the Western Division Meeting, Canadian Anaesthetists' Society, Edmonton, Alberta, March 1, 2, 3, 1962.






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Copyright © 1962 by the Canadian Anesthesiologists' Society.