The Use of Muscle Relaxants in Infants and Children

Abstract

The belief that the use of muscle relaxants in infants and children is both unnecessary and dangerous has not been substantiated by subsequent clinical experience. The important advances that have been made recently in paediatric anaesthesia are due largely to the introduction of muscle relaxants, which have reduced the need for toxic agents to a minimum and have emphasized the importance of control of pulmonary ventilation. Furthermore, muscle relaxants now play an important role in the management of a wide variety of medical and surgical conditions.

Electromyographic Responses to Small Doses of Suxamethonium in Children After Burns

“…BELL Cardiac arrest has occurred following the administration of suxamethonium to burned patients (Fleming et al, 1960), and recognition of this hazard has led to the avoidance of the use of suxamethonium in such patients. Bush (1964) postulated a number of possible mechanisms and, although it was suspected that hyperkalaemia might be the cause, this was not confirmed until Tolmie, Joyce and Mitchell (1967) reported repeated cardiac arrests associated with acute increases in serum potassium concentation in a badly burned soldier in Vietnam. Keneally and Bush (1974) reported a mean maximum change of 0.13 mmol litre" 1 after suxamethonium 1.5mgkg~l in children-the only statistically significant change was in the group aged 5 yr and younger, in which there was a mean maximum increase of 0.23 mmol litre" 1 .…”

Placental Transfer of Tubocurarine. Case Report

“…This is the equivalent in clinical anaesthesia of administering to the child tubocurarine (1.2 mg/kg) assuming that all the dose given stays in the plasma. Bush (1963) in a review of muscle relaxants in paediatric anaesthesia, quotes doses of 0.6 mg/kg as being necessary to curarize a child for 30-45 minutes.…”