To decrease bradyarrhythmias in children during endotracheal intubation, Succinylcholine is given along with?

JODHPUR AIIMS SNO-2018

Pharmacology

Easy

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

Succinylcholine, a muscle relaxant, can cause significant bradycardia (slowing of the heart rate) in children due to stimulation of cardiac muscarinic receptors.
This adverse effect is more common and pronounced in children because of their higher baseline vagal tone compared to adults.
Atropine Sulphate, an anticholinergic drug, is given prophylactically to block these muscarinic receptors and counteract the vagal stimulation, thus preventing the heart rate from dropping during the procedure.

Option A: Xylocaine (Lidocaine) is a local anesthetic. Its purpose during intubation is to suppress the cough reflex and blunt the hypertensive response to laryngoscopy, not to manage heart rate.
Option B: Adrenaline (Epinephrine) is a powerful stimulant used to treat life-threatening conditions like asystole or severe, symptomatic bradycardia. It is a rescue drug, not a prophylactic one in this context.
Option C: Vecuronium is another type of muscle relaxant (non-depolarizing). It is an alternative to succinylcholine, not a drug given alongside it to prevent side effects. It has minimal effects on heart rate.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological prevention of side effects during pediatric intubation as background academic context rather than a clinical decision trigger.
A critical nursing responsibility during pediatric intubation is to anticipate and prevent potential complications. Knowing that succinylcholine causes bradycardia in children allows the nurse to ensure atropine is available and administered per protocol.
Continuous cardiac monitoring is essential. The nurse must closely watch the patient's heart rate and rhythm on the monitor before, during, and after the administration of these medications and alert the team to any significant changes.
What if? If the patient were an adult, routine premedication with atropine before a single dose of succinylcholine is generally not necessary, as the incidence of significant bradycardia is much lower. It is typically reserved for adults receiving a second dose of succinylcholine or those with pre-existing bradycardia.

How to Approach the Question

First, identify the key elements of the question: the drug (Succinylcholine), the patient population (children), the procedure (endotracheal intubation), and the problem to be prevented (bradyarrhythmias).
Recall or deduce the specific side effects of Succinylcholine in children. The most notable cardiovascular side effect in this group is bradycardia.
The question asks for a drug that prevents this side effect. This requires a pharmacological antagonist to the mechanism causing the bradycardia.
Analyze the options based on their drug class and primary function: Xylocaine (anesthetic), Adrenaline (emergency stimulant), Vecuronium (alternative muscle relaxant), and Atropine Sulphate (anticholinergic).
Recognize that an anticholinergic agent is needed to block the muscarinic/vagal stimulation caused by succinylcholine.
Select Atropine Sulphate as it is the classic anticholinergic drug used for this specific purpose.

Concept Tested & Keywords

Concept Tested: Pharmacological prevention of side effects during pediatric intubation.
Stem keywords: bradyarrhythmias, children, endotracheal intubation, Succinylcholine
Lead-in keywords: decrease, given along with
Clinical cues: The patient population is 'children', which is critical as the cardiovascular response to succinylcholine differs from adults.
Negative lead-in flag: false

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E6 Pharmacology Katzung 16e p. 754-756

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 3 (pp 477-702 of 713) p. 153-155