Abstract
To determine whether the incidence of masseter muscle rigidity is affected by the anaesthetic induction sequence, we prospectively studied for ten months the anaesthetic course in 5,641 infants and children who received muscle relaxation to facilitate tracheal intubation. The anaesthetic induction sequence consisted of intravenous sodium thiopentone (STP) 5 mg · kg−1 alone, halothane induction alone 1–4%, or halothane followed by STP. Inhalational inductions with halothane included nitrous oxide and oxygen. Tracheal intubation was facilitated by either intravenous succinylcholine (Sch) at least 1.5 mg · kg−1 or by a non-depolarizing muscle relaxant. The induction sequence and all episodes of MMR were recorded. Ninety percent of the patients received Sch and 10% received a non-depolarising agent. Of those who received Sch, 88% (5,064 patients) were anaesthetised with STP and 12% (607 patients) were anaesthetised with halothane alone or halothane followed by STP Masseter muscle rigidity was defined clinically by the transient inability to distract the mandible from the maxilla such that the mouth could not be opened or could only be opened with force. No children anaesthetised with STP followed by Sch developed MMR. One child (0.9%) developed MMR after halothane and Sch and two developed MMR after halothane, STP and Sch (0.4%). The incidence of MMR after Sch was less with STP than with halothane alone or with halothane and STP (P < 0.025). The peak CPK values in the three children who developed MMR were 17,580 IU · L−1 after halothane and Sch, and 7,280 IU·−1 and 3,273 IU ·−1 after halothane, STP and Sch. There was no evidence of MH reactions in these patients. No child developed malignant ventricular arrhythmias or cardiac arrest after Sch or a non-depolarising neuromuscular relaxant. There were no episodes of succinylcholine apnoea. We conclude that MMR is less likely to occur following STP and Sch than after halothane and Sch.
Résumé
Cette travail vise à déterminer si la séquence de l’induction de l’anesthésie a une influence sur l’incidence de la rigidité du muscle masséter (RMM). A cet effet, nous avons mené une étude prospective de dix mois portant sur l’anesthésie de 5,641 nourrisons et enfants au cours de laquelle ils ont reçu un relaxant musculaire pour faciliter l’intubation. A l’induction, la séquence anesthésique était constituée de thiopentone sodique (TPS) 5 mg · kg−1 seul, d’halothane seul à 1–4%, ou d’halothane suivi de TPS. L’induction inhalatoire à l’halothane comprenait du protoxyde d’azote et de l’oxygène. L’intubation trachéale a été facilitée soit par de la succinylcholine intraveineuse (Sch) 1,5 mg · kg−1 ou plus, soit par une relaxant non dépolarisant. La séquence d’induction et tous les épisodes de RMM ont été enregistrés. Quatre-vingt-six pour cent des patients ont reçu de la Sch et 10% un non dépolarisant. Parmi ceux qui ont reçu de la Sch, 88% (5064 patients) ont été anesthésiés avec du TPS et 12% (607) avec de l’halothane seul ou l’halothane suivi de TPS. La rigidité du muscle masséter était définie comme une inhabilité transitoire de séparer la mandibule du maxillaire de façon telle que la bouche ne pouvait être ouverte ou ne pouvait l’être que par la force. Aucun des enfants anesthésiés avec TPS suivi de Sch n’a présenté de RMM. Un enfant (0,9%) a developpé de la RMM après halothane et Sch et deux ont développé de la RMM après halothane, TPS and Sch (0,4%). L’incidence de RMM après Sch a été moins élevée avec TPS qu’avec halothane seul ou halothane et TPS (P < 0,025). Les valeurs maximales des CPK chez les trois enfants qui ont développé de la RMM étaient de 17 580 UI · LT−1 après halothane et Sch, et 7 280 UI · L−1 et 3 273 UI · L−1 après halothane, TPS et Sch. On n’a pas trouvé de signes d’HM chez ces enfants. Aucun des enfants n’a développé d’arrythmies ventriculaires malignes ou d’arrêt cardiaque après Sch ou le non dépolarisant. Il n’ya pas eu d’épisode d’apnée à la succincylcholine. Nous concluons que la RMM est moins susceptible de se produire après TPS et Sch qu ’après halothane et Sch.
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Lazzell, V.A., Carr, A.S., Lerman, J. et al. The incidence of masseter muscle rigidity after succinylcholine in infants and children. Can J Anaesth 41, 475–479 (1994). https://doi.org/10.1007/BF03011540
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DOI: https://doi.org/10.1007/BF03011540