Abstract
This study was designed to compare the effectiveness of pretreatment with the combination of d-tubocurarine and atropine with d-tubocurarine alone in preventing changes in cardiac rate and rhythm following repeated administration of succinylcholine. Sixty subjects were randomly divided into three groups of twenty. Group one received d-tubocurarine 0.04 mg-kg-1 and atropine 0.01 mg-kg-1, and group two d-tubocurarine 0.04 mgkg-1 only, given three minutes before induction of anaesthesia. Group three received no pretreatment. Immediately following thiopentone induction succinylcholine 1 mg-kg-1 was given to all patients. A further dose of succinylcholine 1 mg-kg-1 was given to patients in the pretreatment groups following recovery of neuro-muscular function. Both pretreatment groups showed a small statistically significant fall in mean heart rate after the second dose of succinylcholine. One patient in each pretreatment group showed a fall in heart rate to less than 50 beats min-1; two patients in the group who received both d-tubocurarine and atropine, and three patients in the d-tubocurarine only group, showed a fall in heart rate of 25 per cent or more. It is concluded that the addition of atropine may be unnecessary for prevention of succinylcholine-induced bradydysrhythmias when d-tubocurarine pretreatment is given.
Résumé
L’efficacité d’une injection d’atropine et de d-tubocurarine précédant l’administration de doses répétées de succinylcholine, en vue de prćvenir les modifications de fréquence et de rythme observées dans ces cas, a été comparée à la valeur préventive d’une injection de d-tubocurarine employée seule. L’étude a été conduite chez soixante patients assignés é l’un des trois groupes de vingt patients.
Les patients du groupe I ont reçu, juste avant l ’ induction de l ’ anesthesie, une injection de d-tubocurarine 0.04 mg-kg-1 et d’atropine 0.01 mg-kg-1; ceux du groupe II n’ont reçu que la d-tubocurarine (la meme dose) avant l’induction; ceux du groupe III n’ont pas reç,u de prétraitement. Une dose de succinylcholine à raison de 1 mg-kg-1 était administrée à tous les patients immédiatement après l’induction. Puis dès le retour de la fonction neuro-musculaire, on répétait la même dose de succinylcholine aux patients des groupes I et II. Une diminution légère mais significative de la fréquence cardiaque moyenne a été observéed après la seconde injection de succinylcholine chez les patients de ces deux groupes. Une fréquence inférieure à 50/minute a été notée chez Fun des patients des groupes I et II; deux patients du groupe I (d-tubocurarine et atropine) et trois du groupe II (d’tubocurarine seule) ont présenté une fréquence cardiaque abaissée de 25 pour cent ou plus.
En conclusion, l’addition d’atropine ne semble pas nécessaire pour prévenir les bradyarythmies associées à l’administration de doses répétées de succinylcholine lorsque les malades recoivent un pré-traitement à la d-tubocurarine.
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Magee, D.A., Sweet, P.T. & Holland, A.J.C. Effect of atropin atropin on bradydysrhythmias induced by succinylch oline folloewing pretreatment with d-tubocurarine. Canad. Anaesth. Soc. J. 29, 573–576 (1982). https://doi.org/10.1007/BF03007743
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DOI: https://doi.org/10.1007/BF03007743