RISK OF CARDIAC ARREST FROM HYPERKALEMIC
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 pediatric patients 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 pediatric patients (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 pediatric patients 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).
This drug should be used only by individuals familiar with its actions, characteristics and hazards.
Quelicin (Succinylcholine Chloride Injection, USP) is a sterile, nonpyrogenic solution to be used as a short-acting, depolarizing, skeletal muscle relaxant. See HOW SUPPLIED for summary of content and characteristics of the solutions. The solutions are for I. M. or I. V. use.
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 Quelicin (Succinylcholine)
Anesthesia Technique May Affect Survival After Breast Cancer Surgery: Study
Source: MedicineNet Breast Specialty [2013.10.15]
Title: Anesthesia Technique May Affect Survival After Breast Cancer Surgery: Study
Category: OnHealth Staging
Created: 10/15/2013 4:36:00 PM
Last Editorial Review: 10/15/2013 4:35:43 PM
Anesthesia May Harm Children's Brains
Source: MedicineNet Ear Tubes Specialty [2012.08.20]
Title: Anesthesia May Harm Children's Brains
Category: Health News
Created: 8/20/2012 11:00:00 AM
Last Editorial Review: 8/20/2012 12:00:00 AM
Published Studies Related to Quelicin (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 Quelicin (Succinylcholine)
Rapid Sequence Intubation With Magnesium-rocuronium Compared With Succinylcholine - A Randomised Clinical Study [Recruiting]
Rapid sequence intubation (RSI) is the preferred method of endotracheal intubation in the
emergency setting. The aim of RSI is to achieve rapid unconsciousness and complete
neuromuscular blockade which facilitates endotracheal intubation. RSI is of particular
importance in unfastened patients who are at risk of regurgitation and subsequent aspiration
of stomach contents into the lungs during induction of anaesthesia.
Still today, succinylcholine is the neuromuscular blocking agent of choice for RSI. However,
unfortunately in 60 at 80% the intubations conditions not are excellent and there are
contraindications for the usage of succinylcholine and numerous side effects. Thus there is
a need for alternative techniques that allow for rapid, high-quality and safe intubation
conditions. Magnesium has an impact on neuromuscular transmission; it reduces the amount of
acetylcholine that is released at the motor nerve terminal.
It has been shown that an IV infusion of magnesium sulphate prior to a standard intubation
dose of rocuronium enhanced the speed of onset of the neuromuscular block compared with
rocuronium alone by about 35% and there was much less variability in onset times. This makes
the combination magnesium-rocuronium a potentially interesting alternative to
succinylcholine for RSI.
The investigators objective is to compare in surgical patients during a standardised RSI
procedure intubation conditions with rocuronium 0. 6 mg kg-1 after pre-treatment with
intravenous MgSO4 60 mg kg-1 (experimental intervention) with succinylcholine 1 mg kg-1
(control intervention) and to quantify any minor or major adverse event.
The investigators primary hypothesis is that with rocuronium 0. 6 mg kg-1, after
pre-treatment with MgSO4 60 mg kg-1, the rate of excellent intubation conditions will be
higher (80%) compared with succinylcholine 1 mg kg-1 (60%).
This is a two centre (Division of Anaesthesiology, Geneva University Hospitals and Division
of Anaesthesiology, University Hospital of Lausanne), stratified (male, female), randomised,
double blinded study including 280 patients.
The investigators will compare in surgical patients during a standardised RSI procedure
intubation conditions with rocuronium 0. 6 mg kg-1 after pre-treatment with intravenous MgSO4
60 mg kg-1 (experimental intervention) with succinylcholine 1 mg kg-1 (control
Intubation conditions will be evaluated by the intubating anesthesiologist following
predefined criterias. The intubating anaethesist will not be present at study drug
administration to guaranty blinding. Only two intubating anaesthetists will be identified
per participating centre.
Rapid sequence intubation is a cornerstone of daily anaesthetic practice and succinylcholine
is still the most frequently used neuromuscular agent in this context. In some patients,
succinylcholine is contraindicated and therefore alternatives to this very fast reacting
neuromuscular blocker are needed. If the investigators show that the investigators proposed
magnesium-rocuronium regimen provides better intubation conditions as succinylcholine, the
investigators study is likely to have an important impact on daily clinical practice.
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.
Succinylcholine or Rocuronium for Rigid Bronchoscopy Under General Anesthesia [Recruiting]
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.
Page last updated: 2013-10-15