Neuromuscular blocking agents in children

Abstract

This article will review the pharmacology of muscle relaxants in children. The neuromuscular pharmacology of the very young (infants less than one year) will be discussed in the next issue of the Journal. In this review the neuromuscular blocking drugs will be discussed in the order of their duration of action. Swamethonium and the recently developed shortacting mivacurium will be considered, followed by the two intermediate-acting agents vecuronium and atracurium (see Figure 1). The last group to be discussed will be the long-acting compounds (pancuronium, tubocurarine, metocurine, alcuronium, gallamine, doxacurium and pipecuronium) (see Figure 2 and Table 1). SuxamethoniumSwamethonium (succinyldicholine) is still the shortest acting neuromuscular blocking agent and the only depolarizing compound regularly used in children. Determinations of effective doses have shown that the ED95 in children less than 10 years of age is 0.42-0.45 mgkg-'; in older children (more than 11 years) the ED95 is 0.27 mg-kg-' a value comparable to that in adults (ED95 0.29 mgkg-') (Meakin et al.