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Continuing Education in Anaesthesia, Critical Care & Pain 2007 7(5):143-147; doi:10.1093/bjaceaccp/mkm032
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2007]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Neuromuscular blocking drugs in infants and children

George H Meakin, MD FRCA
Senior Lecturer in Paediatric Anaesthesia
University Department of Anaesthesia
Royal Manchester Children's Hospital
Pendlebury
Manchester M27 4HA, UK
Tel: +44161 992 2291 Fax: +44161 992 2439 E-mail: george.meakin@manchester.ac.uk

Key Words: Paediatric patients differ from adults in their response to neuromuscular blocking agents due to developmental changes in neuromuscular transmission and body composition. • Infants are sensitive to the effects of non-depolarizing neuromuscular blocking agents due to a lack of acetylcholine in developing motor nerves. However, this is largely counterbalanced by the distribution of the drugs into a larger volume of extracellular fluid. • Infants and children require significantly greater per kg doses of succinylcholine compared with adults due to the larger volume of distribution. • Reversal of residual non-depolarizing neuromuscular block is faster in infants and children than in adults following standard doses of edrophonium or neostigmine. • Neuromuscular blocking agents are among the safest drugs given by anaesthetists although anaphylaxis can occur.

The first 150 words of the full text of this article appear below.

Neuromuscular blocking drugs (NMBDs), are given to infants and children for anaesthesia to provide muscle relaxation, to reduce the quantity of anaesthetic agent required and to facilitate controlled ventilation. The effective use of NMBDs in paediatric practice requires a knowledge of certain fundamental differences in the responses of paediatric patients and adults to these drugs, and the physiological factors that underlie them. This review presents a brief account of these differences and an overview of the clinical pharmacology of the most commonly used NMBDs in infants and children.


   Factors affecting paediatric responses to neuromuscular blocking drugs
 
Development of the neuromuscular system

Acetylcholine receptors (AChRs) appear over the entire surface of human muscle fibres at about 8 weeks of gestational age. From 9 to16 weeks, AChRs cluster to form primitive motor-end plates on one side of the muscle fibres. From 16 to 24 weeks the number of nerve terminals is reduced reflecting the transition from poly- to mononeuronal innervation. From 24 to 31 weeks, . . . [Full Text of this Article]

Maturation of neuromuscular transmission

Developmental changes in other body systems


   Depolarizing neuromuscular blocking drugs
 
Succinylcholine


   Non-depolarizing neuromuscular blocking drugs
 
Benzylquinolinium compounds

Atracurium

Cisatracurium

Mivacurium

Aminosteroidal compounds

Pancuronium

Vecuronium

Rocuronium


   Antagonism of neuromuscular blocking drugs
 

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