Role of muscle relaxants in pediatric anesthesia

Abstract

Recent developments in clinical practice have reduced or obviated the need for muscle relaxants in pediatric anesthesia. Muscle relaxants are still indicated for intubation and procedures requiring profound muscle relaxation, and to minimize the amounts of anesthetic drugs given to infants and sick children. Specific relaxants and doses can be chosen to suit the clinical circumstances.

Selection of Anesthesia Techniques for the Neonate

“…Cisatracurium induces less histamine release than atracurium. A dose of 0.15 mg/kg provides excellent intubation conditions after 120 s in infants anesthetized with nitrous oxide-thiopentalfentanyl anesthesia [ 215 ]. In the same study, the onset time was more rapid and the recovery time greater in younger patients.…”

“…On the other hand, atracurium is degraded spontaneously by Hoffman degradation, a process that depends only on pH and temperature [ 215 ]. In patients with a defi ciency in plasma pseudocholinesterase (estimated frequency 1/2,000), mivacurium may cause prolonged neuromuscular blockade.…”

“…Cisatracurium is one of the ten stereoisomers that comprise the muscle relaxant, atracurium [ 215 ]. Cisatracurium induces less histamine release than atracurium.…”

Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

“…Noticeable differences occur in terms of potency and cardiovascular adverse effects. Cisatracurium is four times as potent as atracurium and does not produce any cardiovascular effects, whereas atracurium can cause hypotension and tachycardia (97)(98)(99).…”

Sedation and General Anaesthesia for Colonoscopy in Childhood

“…The introduction of these newer less-toxic, shorter-acting anaesthetic drugs has reduced the requirement for muscle relaxants not only for diagnostic procedures like colonoscopy but also for general surgery in the paediatric population. Moderate anaesthesia conducted with combination of sevoflurane-remifentanil or propofolremifentanil can keep children immobile without producing hypotension and facilitate controlled ventilation once the effects of the intubating dose of a muscle relaxant have worn off (Meakin, 2007, Liao et al, 2010. Neuromuscular blocking agents could be selected only for those indications like difficult airway, higher risk of gastric regurgitation, obesity, and difficulties with patient's position.…”