29 September 2025 : Review article
Age-Specific Pharmacology of Neuromuscular Blocking Agents: A Comprehensive Review
Paweł Radkowski
ABCDEFG 1,2,3, Kacper Kowalczyk ABCDEF 4, Anna Łęczycka ABCDEF 4, Hubert Oniszczuk BDE 5*, Łukasz Grabarczyk DEFG 6
DOI: 10.12659/MSM.949656
Med Sci Monit 2025; 31:e949656
Table 1 NMBAs in children.
| NMBA | Recommended dose | Key considerations |
|---|---|---|
| Succinylcholine | 2–3 mg/kg for neonates and infants1–2 mg/kg for children | Despite some undeniable qualities, it also has dangerous adverse effects, and due to the availability of more reliable substitutes, use of succinylcholine should be limited to exceptional circumstances |
| Atracurium | 0.5 mg/kg | In infants, a sufficient dose might be smaller, at 0.3–0.4 mg/kgSome patients present with histamine-release adverse effects (eg, flushing, bronchospasm, hypotension, and tachycardia) |
| Cisatracurium | 0.15 mg/kg | Due to less significant adverse effects compared to atracurium, it seems to be a safer choice in the pediatric population |
| Mivacurium | 0.15–0.2 mg/kg | If necessary, additional doses should be administrated more often than in adults. Due to possible pseudocholinesterase deficiency, caution is advised |
| Pancuronium | 0.1 mg/kg | Standard dose can be reduced by 25–30% in neonates and infants []69 |
| Vecuronium | 0.1 mg/kg []70 | Standard dose maintains muscle relaxation for 59 minutes in infants and neonates, 18 minutes in children aged 2–10 years, and 37 minutes in adolescents. Therefore, additional doses should be administered less often in infants and neonates |
| Rocuronium | 0.6 mg/kg | In certain cases (eg children under 4 months old), a lower dose (0.3–0.45 mg/kg) can be adequate and efficient |
| Neostigmine | 0.02–0.05 mg/kg | Administer with atropine (0.02 mg/kg) to avoid bradycardiaRisk of bronchospasm, nausea, vomiting, hypersalivation |
| Sugammadex | 2 mg/kg above 2 years old | In children above 2 years old, sugammadex seems to be a better alternative to neostigmineIn younger children, some data indicate the safety of a 2 mg/kg dose, but there is insufficient reliable evidence to recommend widespread use of the drug |