Extreme variability in succinylcholine dose for muscle relaxation in electroconvulsive therapy

Bryson, Ethan O.; Kellner, Charles H.; Li, Erin H.; Aloysi, Amy; Majeske, Matthew

doi:10.1177/1039856218761301

Cited by 11 publications

(6 citation statements)

References 19 publications

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“…Administration of Sux is reported through intravenous, intramuscular, and submental routes. On intravenous injection, onset occurs in 30 seconds with total paralysis in 45 seconds, while on intramuscular injection, the adequate intubating condition is achieved in three to four minutes [ 2 - 4 ]. Rarely, the use of Sux by sublingual via intraoral or submental routes has also been reported [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Succinylcholine (Sux), a depolarizing neuromuscular blocking agent, is an essential drug in anaesthetic management [1]. Though the preferred route of administration is intravenous, intramuscular and sublingual administration have been reported [2][3][4][5]. Although accidental epidural administration of Sux has been reported, there is no literature to guide about the consequences and subsequent management following Sux ingestion.…”

Section: Introductionmentioning

confidence: 99%

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Management of Accidental Succinylcholine Ingestion: Navigating Uncharted Waters

Jain¹,

Singh²,

Karna³

et al. 2022

Cureus

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Accidental oral ingestion of intravenous drugs is rare and under-reported, which may lead to serious morbidity and worsen the outcome for the patient. Though oral ingestion of sedatives and opioid drugs is reported, literature regarding the ingestion of muscle relaxants and subsequent management is limited. We report an interesting case of oral intake of 10 ml (500 mg) of injection Succinylcholine, a depolarizing muscle relaxant, by a psychiatric patient awaiting electroconvulsive therapy (ECT) in the pre-procedure room. We hereby report the subsequent sequence of events along with the suggested recommendations to be followed in the case of such an eventuality. To the best of our knowledge, this is the first case report of oral ingestion of a depolarizing neuromuscular blocking drug and its subsequent consequences.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of Accidental Succinylcholine Ingestion: Navigating Uncharted Waters

Jain¹,

Singh²,

Karna³

et al. 2022

Cureus

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“…The action of succinylcholine is short in onset and is used during a rapid induction of anesthesia, which at a dose of 1 mg/kg body weight is about 45 s, with 10–15 min duration ( Andersson et al, 2019 ). This has to be seen in the light that wide variations in succinylcholine efficacy during ECT anesthesia may require a dose adjustment of 2 SDs either above or below the mean standard dose of around 1 mg/kg body weight ( Bryson et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Risk Assessment of Electroconvulsive Therapy in Clinical Routine: A 3-Year Analysis of Life-Threatening Events in More Than 3,000 Treatment Sessions

Hajak

Hajak²,

Ziegelmayer³

et al. 2021

Front. Psychol.

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Background: Extensive research has reported that electroconvulsive therapy (ECT) can be highly effective in approximately 80% of patients suffering from depression. Its clinical use is mainly limited by historical objections and the concern about unwanted adverse effects (AEs), including serious and potentially life-threatening adverse events (pLTAEs), induced either by ECT or by anesthesia. Objective risk estimation is, therefore, a decisive factor in determining an indication for ECT.Methods: This paper presents a retrospective analysis of 3-year safety protocols and patient files of 157 patients who received a total of 3,106 ECT applications in a psychiatric inpatient setting at a psychiatric community hospital. This patient group comprises 5.3% of inpatients admitted with comparable diagnoses. Adverse events were analyzed from standardized safety protocols and patient files with a focus on pLTAEs.Results: Adverse events were reported for 30 (19.1%) of the 157 participants during 39 (6.1%) of 641 hospital stays. Serious pLTAEs occurred during three electroconvulsive stimulations in three patients, who needed action through the administration of medication or mechanical respiration. No patient suffered permanent damage to health, and no patient died. The incidence of these and other AEs was independent of sex, age, and diagnosis of patients, and anesthesia medication. Minor AEs occurred more often with higher stimulus doses and an increasing number of treatments.Conclusion: The low incidence rate of 0.097% of serious pLTAEs that require medical action may allow the conclusion that ECT is a rather safe treatment when performed in a controlled setting. The beneficial risk profile of ECT performed in the standard care of psychiatric hospitals suggests a more generous indication of this treatment method. We recommend that ECT facilities collect individual safety data to allow a reliable judgment of their institutional ECT risk profile.

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“…Skeletal muscle relaxation is integral to minimize a motor seizure and avoid musculoskeletal injury. The depolarizing neuromuscular relaxant succinylcholine is used at 0.75-1 mg/kg with an elimination half-life of 41 s (Bryson et al 2018). In cases where succinylcholine is contraindicated including neuromuscular disease or injury, burn injury, pseudocholinesterase deficiency, or hyperkalemia, nondepolarizing neuromuscular relaxants are the preferred option (American Psychiatric Association 1990).…”

Section: Surveillance Of Life Indicatorsmentioning

confidence: 99%