Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-11T00:25:04.407Z Has data issue: false hasContentIssue false
  • English
  • Français

Myth: Atropine should be administered before succinylcholine for neonatal and pediatric intubation

Published online by Cambridge University Press:  21 May 2015

Bethany Fleming ,
Maureen McCollough  and
Sean O. Henderson
Bethany Fleming
Affiliation:
Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, Calif.
Maureen McCollough
Affiliation:
Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, Calif.
Sean O. Henderson*
Affiliation:
Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, Calif.
*
Department of Emergency Medicine, LAC + USC Medical Center, 1200 N State St., Rm. 1011, Los Angeles CA 90033; 213 226-6667, fax 213 226-8044sohender@hsc.usc.edu

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Succinylcholine is often used to facilitate neonatal and pediatric rapid sequence intubation in the emergency department, and most relevant literature recommends administering atropine prior to succinylcholine to reduce the risk of bradycardia. Given the potential complications associated with combining these medications, we searched the published literature for evidence supporting this practice. Most studies recommending atropine premedication were undertaken in the operating room setting and pertained to repeated succinylcholine dosing. Furthermore, there is little published evidence to indicate that succinylcholine-related bradycardia is a clinically important side effect. Several authors have called for the practice to cease, but, to date, these calls have gone unheeded. We found no evidence supporting atropine's use in pediatric patients prior to single-dose succinylcholine. Atropine premedication for emergency department rapid sequence intubation is unnecessary and should not be viewed as a “standard of care.”

Keywords

atropinesuccinylcholinepediatric intubation
Type
Medical Mythology • Mythes médicaux
Information
Canadian Journal of Emergency Medicine , Volume 7 , Issue 2 , March 2005 , pp. 114 - 117
Copyright
Copyright © Canadian Association of Emergency Physicians 2005

References

1.Gerardi, MJ, Sacchetti, AD, Cantor, RM, Santamaria, JP, Gausche, M, Lucid, W, et al.Rapid-sequence intubation of the pediatric patient. Ann Emerg Med 1996;28(1):55–74.Google Scholar
2.Walls, RM.Rapid-sequence intubation comes of age. Ann Emerg Med 1996;28(1):79–81.Google Scholar
3.Leigh, MD, McCoy, DD, Belton, MK, Lewis, GB.Bradycardia following intravenous administration of succinylcholine chloride to infants and children. Anesthesiology 1957;18(5):698–702.Google Scholar
4.Luprian, KG, Churchill-Davidson, HC.Effect of suxamethonium on cardiac rhythm. BMJ 1960;4:1774–7.Google Scholar
5.Overton, JH.Common problems in paediatric anaesthesia. Med J Aust 1976;2(23):873–4.Google Scholar
6.Green, DW, Bristow, ASE, Fisher, M.Comparison of i.v. glycopyrrolate and atropine in the prevention of bradycardia and arrhythmias following repeated doses of suxamethonium in children. Br J Anaesth 1984;56(9):981–5.Google Scholar
7.Barrington, KJ, Finer, NN, Etches, PC.Succinylcholine and atropine for premedication of the newborn infant before nasotracheal intubation: a randomized, controlled trial. Crit Care Med 1989;17(12):1293–6.Google Scholar
8.McLeskey, CH, McLeod, DS, Hough, TL, Stallworth, JM.Prolonged asystole after succinylcholine administration. Anesthesiology 1978;49:208.Google Scholar
9.Mathias, JA, Evans-Prosser, CDG, Churchill-Davidson, HC.The role of the non-depolarizing drugs in the prevention of suxam-ethonium bradycardia. Br J Anaesth 1970;42:609–13.Google Scholar
10.Cordero, L, Hon, EH.Neonatal bradycardia following nasopharyngeal stimulation. J Pediatr 1971;78:441.Google Scholar
11.Reid, LC, Brace, DE.Irritation of the respiratory tract and its reflex effect upon the heart. Surg Gynecol Obstet 1940;70:157–62.Google Scholar
12.Brady, JP, Tooley, WH.Cardiovascular and respiratory reflexes in the newborn. Pediatr Clin North Am 1966;13(3):801–21.CrossRefGoogle ScholarPubMed
13.Zuanetti, G, Ferrari, GM, Priori, SG, Schwarz, PJ.Protective effect of vagal stimulation on reperfusion arrhythmias in cats. Circulation Res 1987;61:429–35.CrossRefGoogle ScholarPubMed
14.Adam, RG, Verma, P, Jackson, AJ, Miller, RL.Plasma pharmacokinetics of intravenously administered atropine in normal human subjects. J Clin Pharmacol 1982;22:477–81.CrossRefGoogle Scholar
15.Morton, HG.Atropine intoxication. J Pediatr 1939;14:755.Google Scholar
16.Burstein, CL, LoPinto, FJ, Newman, W.Electrocardiographic studies during endotracheal intubation. I. Effects during usual routine technics. Anesthesiology 1950;11:224–37.Google Scholar
17.King, BD, Harris, LC Jr, Greifenstein, FE, Elder, JD Jr, Dripps, RD.Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anesthesia. Anesthesiology 1951;12:556–66.Google Scholar
18. Craythorne, NWB, Turndorf, H, Dripps, RD.Changes in pulse rate and rhythm associated with the use of succinylcholine in anesthetized children. Anesthesiology 1960;21(5):465–70.CrossRefGoogle Scholar
19.Lipton, EL, Steinschneider, A, Richmond, JB.Autonomic function in the neonate. Pediatrics 1964;33:212–5.Google Scholar
20.Marshall, TA, Deeder, R, Pai, S, Berkowitz, GP, Austin, TL.Physiologic changes associated with endotracheal intubation in preterm infants. Crit Care Med 1984;12(6):501–3.CrossRefGoogle ScholarPubMed
21.Kelly, MA, Finer, NN.Nasotracheal intubation in the neonate: physiologic responses and effects of atropine and pancuronium. J Pediatr 1984;105(2):303–9.CrossRefGoogle ScholarPubMed
22.McAuliffe, G, Bissonnette, B, Boutin, C.Should the routine use of atropine before succinylcholine in children be reconsidered? Can J Anaesth 1995;42(8):724–9.Google Scholar
23.Mirakhur, RK, Clarke, RS, Elliot, J, Dundee, JW.Atropine and glycopyrronium premedication. A comparison of the effects on cardiac rate and rhythm during induction of anaesthesia. Anaesthesia 1978;33(10):906–2.Google Scholar
24.Whyte, S, Birrell, G, Wyllie, J.Premedication before intubation in UK neonatal units. Arch Dis Child 2000;82(1):38–41.CrossRefGoogle ScholarPubMed
25.Parnis, SJ, Van der Walt, JH.A national survey of atropine use by Australian anaesthetists. Anaesth Intensive Care 1994;22(1):61–5.Google Scholar
26.Robinson, AL, Jerwood, DC, Stokes, MA.Routine suxametho-nium in children. A regional survey of current usage. Anaesthesia 1996;51(9):874–8.Google Scholar
27.Schoedstadt, DA, Whitcher, CE.Observations on the mechanisms of succinylcholine-induced cardiac arrhythmias. Anesthesiology 1963;24:359–62.Google Scholar
28.Annila, P, Viitanen, H, Reinikainen, P, Baer, G, Lindgren, L.Induction characteristics of thiopentone/suxamethonium, propofol/alfentanil or halothane alone in children aged 1–3 years. Eur J Anaesthesiol 1999;16(6):359–66.Google Scholar