From the Guidelines
For a 3-year-old child, succinylcholine at a dose of 1.2 mg/kg or rocuronium at a dose higher than 0.9 mg/kg can be considered as muscle relaxants under direct medical supervision in specific clinical contexts such as rapid-sequence induction for tracheal intubation, due to their rapid onset of action and effectiveness in improving intubation conditions. The choice between these two muscle relaxants should be based on the desired duration of muscle relaxation, the risk of difficult intubation, and the presence or risk of a neuromuscular disease, as suggested by the guidelines on muscle relaxants and reversal in anesthesia 1. It's crucial to note that the use of muscle relaxants in children, especially those as young as 3 years old, requires careful consideration due to potential side effects such as drowsiness, confusion, and respiratory depression.
- Key considerations for the use of muscle relaxants in children include:
- The age and weight of the child, as these factors influence the appropriate dosage of the muscle relaxant.
- The specific clinical context, such as the need for rapid-sequence induction for tracheal intubation.
- The potential risks and benefits of using a muscle relaxant, including the risk of anaphylaxis and other adverse reactions.
- The availability of reversal agents, such as sugammadex for rocuronium, to quickly reverse the effects of the muscle relaxant if necessary.
Given the potential risks associated with muscle relaxants in young children, it is essential that any decision to use these medications is made under the guidance of a pediatrician or anesthesiologist, taking into account the child's specific condition, weight, and overall health, as well as the most recent and highest quality evidence available 1.
From the Research
Suitable Muscle Relaxers for a 3-Year-Old Child
The choice of muscle relaxers for a 3-year-old child depends on various factors, including the clinical circumstances and the need for intubation or profound muscle relaxation.
- 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 2.
- Specific relaxants and doses can be chosen to suit the clinical circumstances, such as succinylcholine, a short-acting depolarizing neuromuscular blocker, and pancuronium, a longer-acting, nondepolarizing agent 3.
- The introduction of newer, less-toxic, shorter-acting anesthetic drugs has reduced the requirement for muscle relaxants during surgery, and moderate anesthesia with sevoflurane-remifentanil or propofol-remifentanil can keep patients immobile without producing hypotension 2.
- In the first 2 years of life, there is physical and biochemical maturation of the neuromuscular junction, and neonates and young infants are resistant to both depolarizing and non-depolarizing muscle relaxants on a weight basis 4.
- Benzodiazepines, a class of sedative and anxiolytic medication, may adversely impact respiration, but their use as muscle relaxants in children is not directly addressed in the available studies 5.
Considerations for Muscle Relaxant Use in Children
- The use of muscle relaxants in children requires careful consideration of the clinical response and non-neuromuscular blocking properties of the relaxants 4.
- The choice of muscle relaxant and dosage should be based on the individual child's needs and clinical circumstances, taking into account factors such as age, weight, and medical condition 2, 3.
- Recent developments in clinical practice have reduced or obviated the need for muscle relaxants in pediatric anesthesia, but they are still indicated for specific procedures and situations 2.