WARNING
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).
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ANECTINE SUMMARY
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.
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NEWS HIGHLIGHTSMedia Articles Related to Anectine (Succinylcholine)
Abdominal Surgery Without General Anesthesia
Source: GastroIntestinal / Gastroenterology News From Medical News Today [2009.11.04]
A recent review in Faculty of 1000 Medicine Reports, a publication in which clinicians highlight advances in medical practice, suggests regional pain relief could be used during abdominal surgery. In this review, Michael Schaefer recommends a new approach that can be performed without the need for general anaesthetics.
Anesthesia, Exertional Heat Deaths May Be Linked
Source: MedicineNet Hyperthermia Specialty [2009.10.26]
Title: Anesthesia, Exertional Heat Deaths May Be Linked
Category: Health News
Created: 10/23/2009 4:10:00 PM
Last Editorial Review: 10/26/2009
Anesthesia in Youngest Kids May be Linked to Learning Disabilities
Source: MedicineNet Hernia Specialty [2009.03.25]
Title: Anesthesia in Youngest Kids May be Linked to Learning Disabilities
Category: Health News
Created: 3/25/2009 2:00:00 AM
Last Editorial Review: 3/25/2009
Need For Emergency Airway Surgery For Hard-to-Intubate Patients Reduced
Source: Respiratory / Asthma News From Medical News Today [2009.11.18]
Be prepared, that old Boy Scout motto, is being applied with great success to operating room patients whose anatomy may make it difficult for physicians to help them breathe during surgery, Johns Hopkins researchers report in a new study. When patients undergo general anesthesia, they stop breathing on their own and anesthesiologists must quickly insert a tube into the airway as a first step in machine-assisted breathing.
New Technique For Injectable Facial Fillers Improves Comfort, Recovery
Source: Cosmetic Medicine / Plastic Surgery News From Medical News Today [2009.10.29]
Less pain during injections for wrinkle-fighting facial fillers. Less swelling afterward. Less time in the office waiting for anesthesia to take effect. These and other benefits of a new injection technique that UT Southwestern Medical Center plastic surgeons are helping pioneer are outlined in the October issue of Plastic and Reconstructive Surgery.
Published Studies Related to Anectine (Succinylcholine)
Excellent intubating conditions with remifentanil-propofol and either low-dose rocuronium or succinylcholine. [2009.07]
PURPOSE: The shortest time to tracheal intubation, the best intubating conditions, and the shortest duration of muscle paralysis are achieved with succinylcholine. During a lidocaine-remifentanil-propofol induction of anesthesia, we compared intubating conditions 90 s after administering low-dose rocuronium (0.3 mg . kg(-1)) with intubating conditions 60 s after administering succinylcholine 1.5 mg . kg(-1)... CONCLUSION: During a lidocaine-remifentanil-propofol induction of anesthesia, rocuronium 0.3 mg . kg(-1) administered before the induction sequence provides intubating conditions comparable to those achieved with succinylcholine 1.5 mg . kg(-1) administered after the induction sequence.
Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine. [2009.05]
BACKGROUND: Rocuronium in intubation doses provides similar intubation conditions as succinylcholine, but has a longer duration of action. This study compared time to sugammadex reversal of profound rocuronium-induced neuromuscular block with time to spontaneous recovery from succinylcholine... CONCLUSION: Reversal of profound high-dose rocuronium-induced neuromuscular block (1.2 mg/kg) with 16 mg/kg sugammadex was significantly faster than spontaneous recovery from 1 mg/kg succinylcholine.
[Evaluation of tracheal intubation conditions in morbidly obese patients: a comparison of succinylcholine and rocuronium] [2009.01]
CONCLUSION: These results suggest that administration of succinylcholine calculated based on real weight or ideal weight and rocuronium based on real weight can provide clinically acceptable conditions for tracheal intubation in morbidly obese patients with no other difficult-intubation criteria.
Effect of dexmedetomidine premedication on the intraocular pressure changes after succinylcholine and intubation. [2008.04]
BACKGROUND: Succinylcholine is still recommended for some situations in open globe injuries. However, the use of succinylcholine is associated with an increase in intraocular pressure (IOP). This may be deleterious in open globe injuries. No method has previously been shown to abolish completely this rise in the IOP. We investigated whether dexmedetomidine, an alpha-2 agonist, could attenuate this increase in the IOP after succinylcholine and intubation... CONCLUSIONS: We conclude that dexmedetomidine could be a beneficial premedication in open globe injuries.
Lidocaine or diazepam can decrease fasciculation induced by succinylcholine during induction of anesthesia. [2006.06]
Succinylcholine is used during induction of anesthesia, and it may induce fasciculations. In this study we demonstrated that intravenous diazepam (1 mg/kg) or lidocaine (1.5 mg/kg) can decrease fasciculations induced by succinylcholine.There is no significant difference between these two drugs in reducing fasciculations moreover, these drugs can also prevent raised blood pressure and heart rate during intubation.
Clinical Trials Related to Anectine (Succinylcholine)
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.
Comparison of Rocuronium 1.2 mg/kg Followed by Org 25969 16 mg/kg at 3 Minutes With Succinylcholine 1.0 mg/kg [Completed]
The purpose of the trial is to demonstrate a faster recovery from neuromuscular block induced
by 1. 2 mg/kg Zemuron® after reversal at 3 minutes by 16. 0 mg/kg of Org 25969 compared with
recovery after a neuromuscular block induced by 1. 0 mg/kg succinylcholine.
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.
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Page last updated: 2009-11-18
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