BNF for Children (BNFC) 2018-2019

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NEUROMUSCULAR BLOCKING DRUGS›


DEPOLARISING


Suxamethonium chloride


(Succinylcholine chloride)


lDRUG ACTIONSuxamethonium acts by mimicking
acetylcholine at the neuromuscular junction but
hydrolysis is much slower than for acetylcholine;
depolarisation is therefore prolonged, resulting in
neuromuscular blockade.


lINDICATIONS AND DOSE
Neuromuscular blockade (short duration) during surgery
▶BY INTRAVENOUS INJECTION
▶Neonate: 2 mg/kg, produces 5 – 10 minutes
neuromuscular blockade.

▶Child 1–11 months: 2 mg/kg
▶Child 1–17 years: 1 mg/kg
▶BY INTRAMUSCULAR INJECTION
▶Neonate:Up to 4 mg/kg, produces 10 – 30 minutes
neuromuscular blockade.

▶Child 1–11 months:Up to 5 mg/kg
▶Child 1–11 years:Up to 4 mg/kg (max. per dose 150 mg)
PHARMACOKINETICS
▶Intramuscular injection has a duration of onset of
2 – 3 minutes.

IMPORTANT SAFETY INFORMATION

Should only be administered by, or under the direct
supervision of, personnel experienced in its use.

lCONTRA-INDICATIONSDuchenne muscular dystrophy.
family history of malignant hyperthermia.hyperkalaemia.
low plasma-cholinesterase activity (including severe liver
disease).major trauma.neurological disease involving
acute wasting of major muscle.personal or family history
of congenital myotonic disease.prolonged immobilisation
(risk of hyperkalaemia).severe burns


lCAUTIONSCardiac disease.neuromuscular disease.raised
intra-ocular pressure (avoid in penetrating eye injury).
respiratory disease.severe sepsis (risk of hyperkalaemia)


lINTERACTIONS→Appendix 1 : suxamethonium


lSIDE-EFFECTS
▶Common or very commonArrhythmias.flushing.muscle
contractions involuntary.myoglobinaemia.
myoglobinuria.rash
▶Rare or very rareApnoea.cardiac arrest.hypersensitivity.
malignant hyperthermia.respiratory disorders.trismus
SIDE-EFFECTS, FURTHER INFORMATIONPremedication with
atropine reduces bradycardia associated with
suxamethonium use.


lALLERGY AND CROSS-SENSITIVITYAllergic cross-reactivity
between neuromuscular blocking drugs has been reported;
caution is advised in cases of hypersensitivity to these
drugs.


lPREGNANCYMildly prolonged maternal neuromuscular
blockade may occur.


lBREAST FEEDINGUnlikely to be present in breast milk in
significant amounts (ionised at physiological pH). Breast-
feeding may be resumed once the mother recovered from
neuromuscular block.
lHEPATIC IMPAIRMENTProlonged apnoea may occur in
severe liver disease because of reduced hepatic synthesis
of pseudocholinesterase.


lDIRECTIONS FOR ADMINISTRATIONForintravenous
injection, give undiluted or dilute with Glucose 5 %or
Sodium Chloride 0. 9 %.

lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: solution for injection
Solution for injection
▶Suxamethonium chloride (Non-proprietary)
Suxamethonium chloride 50 mg per 1 mlSuxamethonium chloride
100 mg/ 2 ml solution for injection ampoules| 10 ampouleP
£ 28. 80 – £ 50. 00
▶Anectine(Aspen Pharma Trading Ltd)
Suxamethonium chloride 50 mg per 1 mlAnectine 100 mg/ 2 ml
solution for injection ampoules| 5 ampouleP£ 3. 57

NEUROMUSCULAR BLOCKING DRUGS›NON-
DEPOLARISING

Non-depolarising f


neuromuscular blocking drugs


IMPORTANT SAFETY INFORMATION
Non-depolarising neuromuscular blocking drugs should
only be administered by, or under direct supervision of,
personnel experienced in their use, with adequate
training in anaesthesia and airway management.

lCAUTIONSBurns (resistance can develop, increased doses
may be required).cardiovascular disease (reduce rate of
administration).electrolyte disturbances (response
unpredictable).fluid disturbances (response
unpredictable).hypothermia (activity prolonged, lower
doses required).myasthenia gravis (activity prolonged,
lower doses required).neuromuscular disorders (response
unpredictable)
lSIDE-EFFECTS
▶Common or very commonFlushing.hypotension
▶UncommonBronchospasm.hypersensitivity.skin
reactions.tachycardia
▶Rare or very rareCirculatory collapse.muscle weakness.
myopathy (after prolonged use in intensive care).shock
lALLERGY AND CROSS-SENSITIVITYAllergic cross-reactivity
between neuromuscular blocking drugs has been reported;
caution is advised in cases of hypersensitivity to these
drugs.
lPREGNANCYNon-depolarising neuromuscular blocking
drugs are highly ionised at physiological pH and are
therefore unlikely to cross the placenta in significant
amounts.
lBREAST FEEDINGNon-depolarising neuromuscular
blocking drugs are ionised at physiological pH and are
unlikely to be present in milk in significant amounts.
Breast-feeding may be resumed once the mother has
recovered from neuromuscular block.
eiiiiFabove

Atracurium besilate


(Atracurium besylate)


lINDICATIONS AND DOSE
Neuromuscular blockade (short to intermediate duration)
for surgery
▶INITIALLY BY INTRAVENOUS INJECTION
▶Neonate:Initially 300 – 500 micrograms/kg, followed by
(by intravenous injection) 100 – 200 micrograms/kg,
repeated if necessary, alternatively (by intravenous
infusion) 300 – 400 micrograms/kg/hour, adjusted
according to response.
continued→

BNFC 2018 – 2019 Neuromuscular blockade 813


Anaesthesia

15

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