RISK OF CARDIAC ARREST FROM HYPERKALEMIC RHABDOMYOLYSIS
There have been rare reports of acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death after the administration of succinylcholine to apparently healthy children who were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne's muscular dystrophy.
This syndrome often presents as peaked T-waves and sudden cardiac arrest within minutes after the administration of the drug in healthy appearing children (usually, but not exclusively, males, and most frequently 8 years of age or younger). There have also been reports in adolescents.
Therefore, when a healthy appearing infant or child develops cardiac arrest soon after administration of succinylcholine not felt to be due to inadequate ventilation, oxygenation, or anesthetic overdose, immediate treatment for hyperkalemia should be instituted. This should include administration of intravenous calcium, bicarbonate, and glucose with insulin, with hyperventilation. Due to the abrupt onset of this syndrome, routine resuscitative measures are likely to be unsuccessful. However, extraordinary and prolonged resuscitative efforts have resulted in successful resuscitation in some reported cases. In addition, in the presence of signs of malignant hyperthermia, appropriate treatment should be instituted concurrently.
Since there may be no signs or symptoms to alert the practitioner to which patients are at risk, it is recommended that the use of succinylcholine in children should be reserved for emergency intubation or instances where immediate securing of the airway is necessary, e.g. laryngospasm, difficult airway, full stomach, or for intramuscular use when a suitable vein is inaccessible (see PRECAUTIONS: Pediatric Use and DOSAGE AND ADMINISTRATION).
Anectine® (succinylcholine chloride injection, USP)
ANECTINE (succinylcholine chloride) is an ultra short-acting depolarizing-type, skeletal muscle relaxant for intravenous (IV) administration.
Succinylcholine chloride is indicated as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Media Articles Related to Anectine (Succinylcholine)
General Anesthesia May Negate Endovascular Benefit in Stroke
Source: Medscape Critical Care Headlines [2015.02.17]
Subgroup analysis of the MR CLEAN trial has shown that patients who underwent endovascular clot retrieval under general anesthesia did not show the benefit seen overall in the trial.
Medscape Medical News
The Death of Joan Rivers: Endoscopy and Anesthesia Risks
Source: MedicineNet Heart Attack Pathology: Photo Essay Specialty [2014.12.09]
Title: The Death of Joan Rivers: Endoscopy and Anesthesia Risks
Category: Doctor's Views
Created: 9/8/2014 12:00:00 AM
Last Editorial Review: 12/9/2014 12:00:00 AM
Parsing Out Best Practices for Endovascular Thrombectomy (CME/CE)
Source: MedPage Today Emergency Medicine [2015.02.16]
(MedPage Today) -- "Time is brain" in endovascular thrombectomy, more evidence against general anesthesia.
Published Studies Related to Anectine (Succinylcholine)
Succinylcholine versus rocuronium for rapid sequence intubation in intensive care: a prospective, randomized controlled trial. [2011.08.16]
INTRODUCTION: Succinylcholine and rocuronium are widely used to facilitate rapid sequence induction (RSI) intubation in intensive care. Concerns relate to the side effects of succinylcholine and to slower onset and inferior intubation conditions associated with rocuronium. So far, succinylcholine and rocuronium have not been compared in an adequately powered randomized trial in intensive care. Accordingly, the aim of the present study was to compare the incidence of hypoxemia after rocuronium or succinylcholine in critically ill patients requiring an emergent RSI... CONCLUSIONS: In critically ill patients undergoing emergent RSI, incidence and severity of oxygen desaturations, the quality of intubation conditions, and incidence of failed intubation attempts did not differ between succinylcholine and rocuronium. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT00355368.
Consequences of succinylcholine administration to patients using statins. [2011.07]
BACKGROUND: Statins cause structural changes in myocytes and provoke myotoxicity, myopathy, and myalgias. Thus, patients taking statins may be especially susceptible to succinylcholine-induced muscle injury. The authors tested the hypothesis that succinylcholine increases plasma concentrations of myoglobin, potassium, and creatine kinase more in patients who take statins than in those who do not and that succinylcholine-induced postoperative muscle pain is aggravated in statin users... CONCLUSIONS: The plasma myoglobin concentration at 20 min was significantly greater in statin users than nonusers, although the difference seems unlikely to be clinically important. The study results suggest that the effect of succinylcholine given to patients taking statins is likely to be small and probably of limited clinical consequence.
Desaturation following rapid sequence induction using succinylcholine vs. rocuronium in overweight patients. [2011.02]
BACKGROUND: Rapid sequence induction may be associated with hypoxemia. The purpose of this study was to investigate the possible difference in desaturation during rapid sequence induction in overweight patients using either succinylcholine or rocuronium... CONCLUSIONS: Succinylcholine was associated with a significantly more rapid desaturation and longer recovery of oxygen saturation than rocuronium during rapid sequence induction in overweight patients. (c) 2011 The Authors. Journal compilation (c) 2011 The Acta Anaesthesiologica Scandinavica Foundation.
Remifentanil attenuates muscle fasciculations by succinylcholine. [2010.07]
PURPOSE: The present visual and electromyographic study was designed to evaluate muscle fasciculations caused by succinylcholine in adults pretreated with either remifentanil 1.5 microg/kg or saline... CONCLUSION: Remifentanil 1.5 microg/kg attenuated intensity of muscle fasciculations by succinylcholine.
Comparison of atracurium and "mini-dose" succinylcholine for preventing succinylcholine-induced muscle fasciculations: a randomized, double-blind, placebo-controlled study. [2010.03]
Several drugs have been used to prevent or attenuate succinylcholine- induced muscle fasciculations. There are possible advantages to succinylcholine pretreatment. We designed the present study to compare the effectiveness of atracurium versus "mini-dose" (5 mg) succinylcholine pretreatment for the prevention of muscle fasciculations... CONCLUSION: Our results showed that the incidence and severity of fasciculations were significantly decreased by atracurium pretreatment but not by pretreatment with succinylcholine or placebo (p<0.0001 and p=0.0003 respectively). However, atracurium did not exert significant effects on POM. 2010 Taiwan Society of Anesthesiologists. Published by Elsevier B.V. All rights reserved.
Clinical Trials Related to Anectine (Succinylcholine)
Optimal Dose of Succinylcholine and Rocuronium for Electroconvulsive Therapy (ECT) [Recruiting]
Electroconvulsive therapy (ECT) is the transcutaneous application of small electrical
stimuli to the brain to produce generalized seizures for the treatment of selected
psychiatric disorders such as severe depression. The aim of ECT is to induce a therapeutic
tonic seizure where the person loses consciousness and has convulsions. Patients need
general anesthesia and neuromuscular blockade to treat pain and avoid excessive tonic clonic
motor contraction that might be associated with compression fractures. Neuromuscular
blocking drugs (NMBD) are, therefore, administered after induction of general anesthesia to
induce neuromuscular blockade. Despite the importance of NMBDs to provide optimal conditions
for ECT treatment, the optimal NMBD dose to achieve acceptable neuromuscular blockade
without excessive or untoward effects has not previously been identified in any study and in
a prospective randomized fashion. The aim of this study is, therefore, to identify the
optimal NMBD dose of two commonly used neuromuscular blocking agents (succinylcholine and
rocuronium) in order to optimize the muscle strength modulation during ECT that facilitates
ECT with the minimal side effects.
Reversal With Sugammadex in Short Procedures in Out-patient Surgicenters as Compared to Succinylcholine Alone (19.4.319)(P05700) [Recruiting]
A multi-center, randomized, parallel group, comparative, active controlled, safety assessor
blinded trial in adult subjects comparing rocuronium plus sugammadex versus succinylcholine
alone in subjects undergoing short surgical procedures in out-patient surgicenters. The
primary objective is to evaluate changes in plasma potassium levels after treatment with
rocuronium, sugammadex, and succinylcholine in adult subjects scheduled for short surgical
procedures in out-patient surgicenters.
Effect of Succinylcholine on Patients Using Statins [Recruiting]
Based on available mechanistic and clinical information, the investigators propose a
nonrandomized study to evaluate the effect of succinylcholine in patients taking statins.
The investigators' purpose is to evaluate the effect of succinylcholine on patients taking
statins. Patients scheduled to undergo elective surgery (other then orthopedic, spinal,
vascular or muscle) with planned endotracheal intubation will be approached regarding
participation in the trial. Design of the study is complex because there is no way to
randomize patients to statins or no statins and also no way to take them off the statins
prior surgery. So statin use will not be randomized; confounding factors will be accounted
for by stratification (every 10 years of age from 40-80 and gender) and statistical
adjustment. The investigators propose to test the hypothesis that succinylcholine
administration increases plasma myglobulin concentration more in patients who are on statins
compared to patients who do not.
Succinylcholine Versus Rocuronium for Emergency Intubation in Intensive Care [Recruiting]
Emergency intubation of patients in intensive care is a high-risk endeavour. For many
decades, succinylcholine has been the neuromuscular blocking agent of choice. However,
succinylcholine may have life-threatening side effects and is contraindicated in a variety
of diseases relevant in intensive care. The nondepolarizing agent rocuronium has been
propagated as alternative for succinylcholine. Though a recent meta-analysis found no
difference in intubating conditions between succinylcholine and rocuronium in elective
cases, there are no data in emergent cases in intensive care. The aim of the present study
is to compare succinylcholine and rocuronium with regard to 1) quality of intubating
conditions, 2) length of the intubating sequence, 3) failed intubating attempts, 4)
hemodynamic sequelae of intubation, and 5) desaturations.
Rapid Sequence Intubation With Rocuronium-Sugammadex Compared With Succinylcholine [Recruiting]
Rapid sequence intubation is used, when there is an elevated risk of aspiration to the lungs
of stomach content. It is typically used in acute settings that require acute surgery or in
prehospital settings, but also in specific risk patients requiring elective surgery. The
reason for conducting rapid sequence intubation is to minimize the risk of pulmonary
aspiration and at the same time achieve a fast induction of anaesthesia and intubation.
Rapid sequence intubation is a procedure with a high risk of complications in itself. The
time period from induction of anaesthesia to intubation is particularly risky, because the
patient is apneic. This study addresses this problem by investigating, how quickly
spontaneous respiration can be reestablished after a rapid sequence intubation when using
Rocuronium-Sugammadex compared to Succinylcholine. This is a pilot protocol that is intended
to establish a sample size for the full protocol.
Study hypothesis: The time from correct tube placement to spontaneous respiration is shorter
when using Rocuronium/Sugammadex compared to Succinylcholine.
Page last updated: 2015-02-17