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Myth: Atropine should be administered before succinylcholine for neonatal and pediatric intubation

Published online by Cambridge University Press:  21 May 2015

Bethany Fleming ,
Maureen McCollough  and
Sean O. Henderson
Bethany Fleming
Affiliation:
Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, Calif.
Maureen McCollough
Affiliation:
Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, Calif.
Sean O. Henderson*
Affiliation:
Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, Calif.
*
Department of Emergency Medicine, LAC + USC Medical Center, 1200 N State St., Rm. 1011, Los Angeles CA 90033; 213 226-6667, fax 213 226-8044sohender@hsc.usc.edu

Abstract

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Succinylcholine is often used to facilitate neonatal and pediatric rapid sequence intubation in the emergency department, and most relevant literature recommends administering atropine prior to succinylcholine to reduce the risk of bradycardia. Given the potential complications associated with combining these medications, we searched the published literature for evidence supporting this practice. Most studies recommending atropine premedication were undertaken in the operating room setting and pertained to repeated succinylcholine dosing. Furthermore, there is little published evidence to indicate that succinylcholine-related bradycardia is a clinically important side effect. Several authors have called for the practice to cease, but, to date, these calls have gone unheeded. We found no evidence supporting atropine's use in pediatric patients prior to single-dose succinylcholine. Atropine premedication for emergency department rapid sequence intubation is unnecessary and should not be viewed as a “standard of care.”

Keywords

atropinesuccinylcholinepediatric intubation
Type
Medical Mythology • Mythes médicaux
Information
Canadian Journal of Emergency Medicine , Volume 7 , Issue 2 , March 2005 , pp. 114 - 117
Copyright
Copyright © Canadian Association of Emergency Physicians 2005

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