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


METHODS
Prospective, randomized, double-blinded study.


METHODS
Operating room at a children's hospital.


METHODS
45 ASA physical status IE children, aged 3 to 15 years, scheduled for emergency surgery.


METHODS
The children received either normal saline 0.5 mL, mivacurium chloride 0.03 mg. kg(-1), or gallamine triethiodide 0.04 mg. kg(-1)2 minutes prior to rapid sequence induction (RSI) using thiopental sodium 5 mg. kg(-1), fentanyl 2 microg. kg(-1), and succinylcholine 2 mg. kg(-1).


METHODS
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.


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.
Theroux
M C
MC
Department of Anesthesiology and Critical Care Medicine, Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA. mtheroux@nemours.org
Rose
J B
JB
Iyengar
S
S
Katz
M S
MS
D000293:Adolescent; D000758:Anesthesia; D002648:Child; D002675:Child, Preschool; D003402:Creatine Kinase / Q000097:blood; D004311:Double-Blind Method; D004632:Emergency Medical Services; D005260:Female; D005703:Gallamine Triethiodide; D006801:Humans; D007546:Isoquinolines; D008297:Male; D000077590:Mivacurium; D009211:Myoglobin / Q000378:metabolism; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D010149:Postoperative Pain / Q000453:epidemiology; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D013390:Succinylcholine
D007546:Isoquinolines; D009211:Myoglobin; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium; D003402:Creatine Kinase; D013390:Succinylcholine; D005703:Gallamine Triethiodide; D011188:Potassium