Suxamethonium-Induced Prolonged Apnoea in a Premature Neonate

CASE HISTORY A three-week-old infant weighing 2250 g presented for insertion of a Rickham's reservoir for increasing hydrocephalus. The child had been born vaginally at 33 weeks gestation to a 28-year-old mother with severe pre-eclampsia. The perinatal course was complicated by convulsions and frequent apnoeas thought to be due to sepsis on day 2. Cranial ultrasound revealed biventricular haemorrhages and periventricular leukomalacia. He wa~ extubated on day 4. Serial cranial ultrasound examinations revealed increasing lateral ventricular size secondary to post haemorrhagic hydrocephalus. A Rickham's reservoir was planned as repeated CSF drainage was unsuccessful in controlling the hydrocephalus. All routine clinical chemistry results were normal. The child had not been on antibiotics for three days prior to surgery and was not receiving any systemic medication. No premedication was prescribed. Anaesthesia was induced with oxygen, air and halothane using a Mapleson F system. Intravenous atropine 0.05 mg was administered followed by suxamethonium 5 mg and the trachea was intubated with a 3 mm Portex orotracheal tube. Anaesthesia was maintained with oxygen, air and halothane 0.25070 and muscle relaxation was continued with atracurium 0.8 mg. Ventilation was controlled