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British Journal of Anaesthesia, Vol 83, Issue 1 58-64, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia

THE PAEDIATRIC PATIENT

Neuromuscular blocking agents in paediatric anaesthesia

D. M. Fisher
Department of Anesthesia, University of California, San Francisco, CA 94143-0648, USA

Neuromuscular blocking agents are used commonly in paediatric anaesthesia, both to facilitate tracheal intubation and during surgery. Paediatric patients differ from adults in certain pharmacokinetic and pharmacodynamic characteristics. However, because maturational changes in certain of these characteristics counterbalance, dosing requirements do not differ markedly with age. In general, onset is more rapid in paediatric patients than in adults. Succinylcholine is still used commonly in children, despite restrictions by regulatory authorities, because of its rapid onset and offset. However, newer non-depolarizing neuromuscular blocking agents, particularly mivacurium, rocuronium and rapacuronium, offer many of the advantages of succinylcholine without its severe adverse effects: rocuronium and rapacuronium have an onset comparable with that of succinylcholine whereas the onset of mivacurium is slightly longer. In addition, recovery from an intubating dose of either mivacurium or rapacuronium is nearly comparable with that of succinylcholine. If rapacuronium i.m. proves to have a rapid onset without prolonged duration, the remaining value of succinylcholine will diminish.
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