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  • Title: Tachyphylaxis and phase II block development during infusion of succinylcholine in children.
    Author: DeCook TH, Goudsouzian NG.
    Journal: Anesth Analg; 1980 Sep; 59(9):639-43. PubMed ID: 7191220.
    Abstract:
    Contraction of the adductor of the thumb in response to ulnar nerve stimulation during continuous infusion of succinylcholine (SCh) was evaluated in 22 children anesthetized with halothane (1% to 1.5%) and N2O/O2. Twitch rates of 0.1 Hz were used to evaluate the force of contraction. Train-of-four stimulation (2 Hz for 2 seconds) was used to differentiate between phase I and phase II block. Tachyphylaxis to the effects of SCh occurred in 23 +/- 2 minutes in all children at a mean (+/- SE) dose of 3.0 +/- 0.4 mg/kg of SCh. In 21 of the 22 children, phase II block, as defined by a train-of-four ratio less than 50%, occurred in 29 +/- 5 minutes after 4.1 +/- 0.6 mg/kg of SCh. A mean dose of 10.3 +/- 0.6 mg/kg of SCh administered in a span of 71 +/- 5 minutes produced a mean train-of-four ratio of 12 +/- 5%. The recovery from phase II block after 10.3 +/- 0.6 mg/kg of SCh to train-of-four ratios of 50% and 75% was 16 +/- 3 minutes and 41 +/- 5 minutes, respectively. Caution should be used when more than 3 mg/kg of SCh is infused intravenously; adequate neuromuscular monitoring should be available and ample time should be given for spontaneous recovery.
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