The Inhibitory Effect of Intravenous d -Tubocurarine and Oral Dantrolene on Halothane-Succinylcholine-induced Myoglobinemia in Children

Bisbenzylisoquinoline Alkaloids

“…Anesthetized, healthy pediatric patients that had been administered the alkaloid and/or dantrolene prior to anesthesia had mean serum myoglobin levels of336 ng/ml. None of these patients showed fasiculation (human) (176).…”

Succinylcholine, fasciculations and myoglobinaemia

“…2,5 High myoglobinaemia and elevation of CPK activity are indicators of muscle injury and serum levels of Mb seem to correlate with the degree of muscle damage. 7 This muscle injury is relatively well tolerated by healthy children and adults, but acute rhabdomyolytic renal failure must be anticipated and prevented in patients at risk. 8-L3…”

“…i-6 These biochemical signs of muscle injury are enhanced by halothane 3-6 and reduced by pretreatment with intravenous (IV) d-tubocurarine (dTc) 2,5-7 and oral dantrolene. 7 Acute rhabdomyolytic renal failure due to a single IV dose of succinylcholine has been described in only seven patients, s-~3 Even so, succinylcholine should be avoided in patients at risk of renal failure secondary to rhabdomyolysis: inherited muscle disorders, postural muscle compression during coma and anaesthesia, vascular occlusion, crush and electrical injury, viral and bacterial infections, hyperpyrexia, bypovolaemia, severe hypokalaemia, alcoholism and impending renal failure. 1~ If it is necessary to give succinylcholine to one of these patients (with a full stomach, for example), it is important to know whether or not myoglobinaemia can be reduced or prevented.…”

“…[15][16] We proposed to evaluate the ability of a small "self-taming" IV dose of succinylcholine (0.1 mg.kg-l) t6 and IV pancuronium (0.02 mg'kg-1) 17 to reduce the elevations in serum Mb induced by halothane and succinylcholine in normal children and compare these methods of pretreatment with d-tubocurarine (dTc) (0.05mg'kg-J). 7 We also examined the correlation between the frequency of muscle fasciculations and the serum levels of Mb.…”