BACKGROUNDSuccinylcholine, a depolarising muscle relaxant possesses a unique property of rapid onset and short duration of action, but is accompanied by side effects such as fasciculations and myalgia. A prospective randomised-controlled trial was designed to assess the effect of a combination of magnesium sulphate with propofol for induction of anaesthesia on succinylcholine-induced fasciculations and myalgia. MATERIALS AND METHODS60 adult patients of ASA status I and II of both sexes for elective surgery under general anaesthesia were randomly allocated into two equal groups, group MG and group NS. The patients of MG group were pretreated with magnesium sulphate 40 mg/kg body weight in 10 mL volume, while patients of NS group were given isotonic saline 0.9% in the same volume (10 mL) intravenously slowly over a period of 10 mins. Anaesthesia was administered with pentazocine 0.6 mg/kg and propofol 2 mg/kg, followed by administration of succinylcholine 2 mg/kg intravenously. Muscle fasciculations were observed and graded as nil, mild, moderate or severe. Postoperative myalgia was assessed after 24 hrs. of surgery and graded as nil, mild, moderate or severe. Observations were made in double blind manner where the observer and the patient were blinded. RESULTSDemographic data and baseline parameters of both groups were comparable (P>0.05). Muscle fasciculations occurred in 66.7% patients of MG group versus 100% patients of NS group with a significant difference (P<0.001). After 24 hrs. of surgery, 12 patients of MG group and 28 patients of NS group had myalgia with a significant difference (P<0.001). Statistically significant difference was found in MAP and heart rate at various intervals between the two groups (P<0.001). CONCLUSIONMagnesium sulphate 40 mg/kg intravenously maybe used with propofol for induction of anaesthesia to control succinylcholineinduced fasciculations and myalgia. KEYWORDSPropofol, Magnesium Sulphate, Succinylcholine, Fasciculations and Postoperative Myalgia. HOW TO CITE THIS ARTICLE: Raman A, Singh RK, Sarwer F, et al. Effect of pretreatment with magnesium sulphate on succinylcholine-induced fasciculations and myalgia. BACKGROUNDSuccinylcholine, a depolarising muscle relaxant was introduced in 1952 by Sleff and Foldes and has a unique place in clinical practice, because it causes quick and excellent skeletal muscle relaxation for few minutes followed by spontaneous recovery. It possesses a unique property of rapid onset and short duration of action, but is accompanied by side effects like muscular fasciculations, myalgias, masseter spasm, hyperkalaemia, rhabdomyolysis, etc. It also increases intracranial pressure, intraocular pressure and intragastric pressure. 1 The pathophysiology of fasciculations is unclear, but it may be induced by axonal depolarisation caused by connection between succinylcholine and presynaptic and cholinergic nicotinic receptors. 2 Many attempts have been made to avoid these undesirable effects, which include pretreatment with rocuronium, 3 Financial or Other, Compe...

Background and Aim: Dexmedetomidine, a congener of clonidine is an α 2 adrenoceptor agonist, commonly used for sedation, also known to have antishivering potential. Its use as an agent to treat and control post-spinal anesthesia shivering has been inadequately studied. This study is thus aimed to evaluate the efficacy, hemodynamic changes and side effects of dexmedetomidine in comparison to tramadol when used to control post-spinal anesthesia shivering. Materials and Methods: A prospective randomized, and doubleblind study was conducted in 60 ASA Grade I and II patients of either gender, aged between 18 and 60 years, undergoing various surgical procedure under spinal-anesthesia and developing shivering. The patients were randomized into two groups of n = 30 each to receive either dexmedetomidine-0.5 µg/kg (Group D) or tramadol-0.5 mg/kg (Group T) as an intravenous infusion on appearance of shivering. The time of onset, grade of shivering, time taken for cessation of shivering, response rate, and adverse effect were observed at scheduled intervals. SPSS-20 was used for statistical analysis, unpaired t-test for numerical data and chi-square test for categorical data. Results: Both the drugs effectively controlled shivering, taking almost the same time for its cessation. It was observed that patients in Group D were found to have a greater sedation score, whereas the side effects such as nausea and vomiting requiring treatment was more in Group T. The incidence of recurrence of shivering was higher in Group T. Conclusions: Dexmedetomidine effectively controls shivering taking almost the same time for cessation as that of tramadol. It provides an additional benefit of intraoperative sedation.

Background: Improved patient safety for those undergoing treatment of head and neck cancers depends on prompt identification of warning indicators from severely critical patients and appropriate treatment. As a result, many hospitals all around the world have implemented quick response techniques, including medical emergency teams (MET), which have systems and personnel that are highly trained to deal with patients who are deteriorating. Nowadays, automated activation and alert programs are also being discussed.Aim: To compare the patient outcomes in two conditions: one before the application of the automated MET alert and activation program and the other after the application of the automated MET alert and an activation program was used.Methods and Materials: There was an examination of clinical data on MET-managed patients before and after the computerized alert and activation approach was put in place. The study comprised all adult head and neck cancer patients who were treated by the MET between March 1, 2017, and December 31, 2021. The physiologic abnormalities of the patient at the moment of the MET initiation were recorded as causes for MET activation when the MET was alerted by the computerized alert, and activation system. From activation through deactivation, the MET intervention lasted. Hospital mortality served as the study's primary outcome. The duration of stay at the hospital and unscheduled ICU hospitalizations were secondary outcomes. Medical records from hospitals were examined retrospectively to get information on clinical outcomes.Results: The percentage of unplanned admissions in ICU was greater in the pre-implementation stage (22.34%) as compared to that in the post-implementation stage (13.56%) (p value<0.001). The duration of stay of patients at the hospital also got reduced in the post-implementation phase (13.23 ±1.47 days) as compared to the pre-implementation stage (24,76± 1.12 days) (p<0.001). The median time of derangement of activation of MET was greater in the pre-implementation stage (62 minutes) as compared to the postimplementation stage (34 minutes) (p-value <0.001). The most common complications leading to MET activation in a pre-implementation phase were neurological and respiratory complications. On the other hand, overall deterioration was the most common cause of MET activation. The mortality rate of patients in the pre-implementation stage was 36.23% as compared to 22.12% in the post-implementation stage (p<0.001). Conclusion:The hospital experienced improved clinical outcomes with the adoption of an automated alarm and activation system using a cumulative weighted scoring methodology, which significantly reduced the time from disruption to MET activation.