Các tuyến đường tiêm bắp chỉ nên được sử dụng truy cập vào tĩnh mạch không có sẵn như là tuyến đường này có một khởi đầu trì hoãn hành động. Succinylcholine có liên quan với sự gia tăng trong (ICP) trong nghiên cứu trên động vật, mặc dù điều này đã không bao giờ được báo cáo ở ngườ | Anesthesia for Pediatric Trauma 163 Succinylcholine the only depolarizing neuromuscular blocking agent available for clinical use is the drug of choice for RSI because it has both a rapid onset and ultrashort duration of action. The recommended dose is 2mg kg IV or 4mg kg IM for infants and children. The intramuscular route should only be used where intravenous access is unavailable as this route has a delayed onset of action. Succinylcholine has been associated with increases in ICP in animal studies although this has never been reported in humans. There is also evidence to suggest that the magnitude of the small increase in ICP after succinylcholine administration is reduced in patients with neurological injury 79 . The increase in ICP associated with coughing and retching during laryngoscopy as a result of inadequate anesthesia and neuromuscular blockade is of far greater magnitude and clinical concern than the theoretical changes in ICP attributed to succinylcholine. Furthermore potential increases in ICP may be effectively controlled by pretreatment with thiopentone or propofol a synthetic opioid and other adjuvants such as lidocaine kg . Over the past decade the routine use of succinylcholine in children has been brought into question due to a small number of reported deaths related to hyperkalemia 80 . These cardiac arrests occurred in young males with undiagnosed myopathies. Failure to diagnose hyperkalemia as the etiology of these malignant arrhythmias and to protect the heart from the arrhythmogenic effects of hyperkalemia by administration of intravenous calcium chloride resulted in difficult resuscitations and deaths. Other adverse effects associated with its use in children include bradycardia malignant hyperthermia masseter muscle rigidity and myalgia. Contraindications to succinylcholine are listed in Table 5. Despite these potential problems succinylcholine remains the preferred neuromuscular blocking agent when the airway must be secured .
