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

Study Objective: To determine if pretreatment with either gallamine or miva curium before succinylcholine in children is associated with reduction in f asciculations; postoperative myalgias; or serum levels of potassium, creati nine phosphokinase (CPK), and myoglobin. Design: Prospective, randomized double-blinded study. Setting: Operating room at a children's hospital. Patients: 45 ASA physical status IE children, aged 3 to 15 years, scheduled for emergency surgery. Interventions: The children received either normal saline 0.5 mt, mivacuriu m chloride 0.03 mg kg(-1), or gallamine triethiodide 0.04 mg.kg(-1) 2 minut es prior to rapid sequence induction (RSI) using thiopental sodium 5 mg kg( -1), fentanyl 2 mug.kg(-1), and succinylcholine 2 mg kg(-1). Measurements: Serum potassium concentration (0, 3, 7.5, and 15 min), myoglo bin concentration (5 and 15 min), and CPK concentration (0 min and 24 hr. F asciculation and myalgia were rated on a 0 to 3 score. Main 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 (0.45vs. 0.0, p = 0. 01), myoglobin at 5 minutes (56vs. 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 succinylch oline when compared with normal saline. Additionally, we found a significan t level of association (p < 0.001) between fasciculation and myoglobin leve ls and fasciculation and CPK levels (p < 0.001). Gallamine was not effectiv e in reducing the increase of potassium, myoglobin, or CPK. However, the do se of gallamine used for pretreatment was 13 times less than the dose of mi vacurium. Conclusions: Administration of mivacurium 0.03 mg.kg(-1) intravenously 2 mi nutes before administration of succinylcholine 2 mg.kg(-1) in children is e ffective in reducing the increase in serum potassium at 5 minutes, the incr ease in myoglobin at 5 minutes and 15 minutes, and the increase in CPK at 2 4 hours. (C) 2001 by Elsevier Science Inc.