Bradycardia and Cardiac Asystole Following a Single Injection of Suxamethonium

Abstract

Twenty cases of severe bradycardia, including 12 cases of cardiac asystole, following administration of a single dose of suxamethonium to 17 adult patients are presented. Treatment consisted of i.v. atropine in 16 cases, and in four cases external cardiac massage or a precordial thump was also given. Remission was complete in all cases. The mechanism is not known, but it is suggested that i.v. administration of fentanyl at induction may enhance the tendency to bradycardia following suxamethonium. Absence of preoperative atropine may also be of importance.

Part 8: Adult Advanced Cardiovascular Life Support

“…Lower-level clinical studies provide conflicting evidence of the benefit of routine use of atropine in cardiac arrest. 34,[295][296][297][298][299][300][301][302][303][304] There is no evidence that atropine has detrimental effects during bradycardic or asystolic cardiac arrest. Available evidence suggests that routine use of atropine during PEA or asystole is unlikely to have a therapeutic benefit (Class IIb, LOE B).…”

Bradycardia during critical care intubation: mechanisms, significance and atropine: Figure 1

“…‘Vagomimetic’ bradycardia, which can be so severe as to provoke asystole, is probably the most important drug-induced bradycardia and is a well-known complication of suxamethonium 5 49. Conversely, the use of non-depolarising muscle relaxants, such as vecuronium, and rocuronium has been shown to have a tendency to attenuate oculocardiac vagal reflex bradycardia 50.…”

Part 8: Advanced Life Support

“…209 One study documented improvement in ROSC (14% versus 0%) when atropine was given to adults in asystolic out-of-hospital cardiac arrest in combination with epinephrine and sodium bicarbonate, but none survived to discharge (LOE 3). 211 Three studies suggested that the use of atropine for treatment of cardiac arrest was not associated with any change in survival (LOE 2 212 ; LOE 5 213,214 ).…”