Which of the following is true concerning succinylcholine use in the pediatric population?
A. Large increases in intragastric pressure are noted in small children after succinylcholine use
B. Intraocular pressure increases after succinylcholine use, but will decrease back to baseline at 2-3 minutes.
C. Increases in intracranial pressure (ICP) after succinylcholine use may be attenuated by the use of a "defasiculating dose" of a non-depolarizing neuromuscular blocking agent.
D. Normal patients with have an increase in potassium levels of 1-1.5 mEq/L after a routine succinylcholine dose
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Answer
The answer is C. Although in adults gastric pressures may increase by as much as 40 cm H20, the lack of musculature in a small child makes these pressure increases less significant. In a small child, the increases in intragastric pressure are mild and are usually less than 5 cm H20. Intraocular pressure increases about 60 seconds after succinylcholine use. This effect will peak at 2-3 minutes and will decrease back to normal values by 5-7 minutes. This increase in IOP and increase in ICP can be attenuated by a "defasiculating dose" of a non-depolarizing neuromuscular blocking agent. The increase in ICP may also be attenuated by hyperventilation, thiopental or lidocaine. Normal patients will have an increase in serum potassium levels of 0.3-0.5 mEq/L after a dose of succinylcholine. This increase will be exaggerated in anyone with increased extrajunctional receptors (burns, spinal cord injury, etc.).
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