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
DOSAGE AND ADMINISTRATION).
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)
Anesthesia Impact on Arterial O2 During Thoracoscopic Surgery
Source: Medscape Anesthesiology Headlines [2017.03.15]
Is either desflurane-remifentanil or propofol-remifentanil anesthesia preferable in terms of oxygenation during one-lung ventilation for thoracoscopic surgery?
Combining dental, medical procedures may safely limit children's anesthesia exposure
Source: Dentistry News From Medical News Today [2016.10.27]
Children who require both dental and non-dental medical procedures should have them completed under one general anesthesia session whenever possible, which is ideal for both the patient and family...
Preoxygenation: Physiologic Basis, Benefits, and Risks
Source: Medscape Anesthesiology Headlines [2017.03.15]
Review the technique of preoxygenation before anesthetic induction, which aims to increase the body's oxygen stores, delaying onset of hypoxemia during apnea.
Anesthesia & Analgesia
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)
Rocuronium Plus Sugammadex Versus Succinylcholine Alone in Participants Undergoing Short Surgical Procedures (19.4.319)(P05700 AM2)(COMPLETED) [Completed]
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 was to evaluate changes in plasma potassium levels after treatment with
rocuronium, sugammadex, or succinylcholine in adult subjects scheduled for short surgical
procedures in out-patient surgicenters.
Rapid Sequence Intubation With Magnesium-rocuronium Compared With Succinylcholine - A Randomised Clinical Study [Completed]
Magnesium accelerates the reaction of rocuronium, a neuromuscular blocker used for muscle
relaxation to ease the intubation during anaesthesia.
Succinylcholine is a very fast reacting neuromuscular blocker. It is often used in emergency
procedures, when rapid intubation is necessary.
We want to now if a perfusion of magnesium before anaesthesia accelerates to such an extent
the reaction of rocuronium that intubation conditions are comparable or even better than
with succinylcholine alone (prior perfusion of saline=placebo)
Phase I Dose Escalation of Monthly Intravenous Ra-223 Dichloride in Osteosarcoma [Recruiting]
The goal of this clinical research study is to find the highest tolerable dose of radium-223
dichloride that can be given to patients with osteosarcoma.
Radium-223 chloride is designed to work like radiation therapy in cells that are actively
making bone. It is designed to target new bone growth in and around bone cancer and may
kill cancer cells.
Phase II Trial of Ra-223 Dichloride and Hormonal Treatment [Recruiting]
The goal of this clinical research study is to learn if XofigoŽ (also called Ra-223
dichloride) combined with hormone therapy and denosumab can help to control breast cancer
that has spread to the bones and/or bone marrow. The safety of this study drug combination
will also be studied.
Optimal Dose of Succinylcholine and Rocuronium for Electroconvulsive Therapy (ECT) [Completed]
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.
Page last updated: 2017-03-15