Fatal hyperkalemia following succinylcholine administration in a child on oral propranolol

Ganigara, Anuradha; Ravishankar, Chandrakala Kunigal; Ramavakoda, Chandrika Yabagodu; Nishtala, Madhavi

doi:10.1515/dmdi-2014-0027

Cited by 11 publications

(3 citation statements)

References 9 publications

(8 reference statements)

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“…We are aware of an infant in our own institution who required cardiopulmonary resuscitation during an episode of bronchial disease while on oral propranolol treatment. Other reports of severe adverse reactions to propranolol include hypoglycaemic coma and fatal hyperkalaemia during general anaesthesia [15,16]. Therefore, it is recommended that infants on systemic propranolol are closely monitored and that parents are counselled to discontinue propanolol during times of poor feeding and respiratory illness and to make the anaesthetist aware of the propanolol treatment [4].…”

Section: Discussionmentioning

confidence: 99%

Topical Timolol for Infantile Haemangioma of the Orbit

Hildebrand

Sipkova

2021

Klin Monbl Augenheilkd

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Infantile haemangiomas (IHs) are the most common benign tumours of the eyelid and orbits in infancy. Beta-blockers, in the form of oral propranolol, have become first-line treatment in severe cases with functionally significant or disfiguring IH. However, adverse drug reactions of oral propranolol in infants are reported in 1 in 11 and serious or potentially life-threatening systemic side effects in 1 in 38, including dyspnoea, hypotension, hyperkalaemia, hypoglycaemia, and cyanosis, therefore requiring careful and close monitoring during the course of systemic treatment. More recently, two large meta-analyses have shown topical beta-blockers, such as timolol maleate 0.5%, to be as effective as oral propranolol in superficial IH, but with no or significantly fewer adverse effects, and have advocated that topical beta-blockers replace oral propranolol as the first-line treatment of superficial IH. We have previously reported the therapeutic response of deep periocular IH to primary topical timolol maleate 0.5% monotherapy. Here we also describe the first successful treatments of large orbital IHs with primary topical timolol maleate 0.5% monotherapy in four infants, resulting in immediate cessation of progression and rapid clinical improvement or resolution in all cases. No adverse effects and no recurrence during long-term follow-up of up to 2.5 years after cessation were seen in any of the patients treated with topical timolol maleate 0.5%.

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Section: Discussionmentioning

confidence: 99%

Topical Timolol for Infantile Haemangioma of the Orbit

Hildebrand

Sipkova

2021

Klin Monbl Augenheilkd

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“…This is in line with the excellent safety record of topical TM 0.5% that has been established in infants and young children, including large case cohorts and meta-analyses 18 , 19 , 20 , and in contrast to oral treatment with propranolol, a lipophilic nonselective β 1- and 2-blocker that has become the first-line treatment since Léauté-Labrèze and colleagues described successful regression of IH in 2008 16 . However, oral propranolol can cause severe and potentially life-threatening systemic adverse reactions, including bronchospasm, bradycardia, cyanosis, hypoglycaemia, and, rarely, deep coma and fatal hyperkalaemia 26 , 27 , 28 . A French report of a very large cohort of 906 infants treated with propranolol at a median dose of 2 mg/kg/d for a median duration of 198 days recorded 81 children (8.94% or 1 : 11 infants) with one or more adverse drug reactions (ADR) and 2.64% (1 : 38 infants) with a serious ADR, defined as “any ADR leading to death, life-threatening injury, hospitalisation, disability or permanent damage, or other important medical events as judged by the investigator” 26 .…”

Section: Discussionmentioning

confidence: 99%

Successful Late Treatment of Orbital Infantile Haemangiomas in Two Teenagers with Topical Transcutaneous Timolol Maleate 0.5% Alone

Hildebrand

Sipkova

2022

Klin Monbl Augenheilkd

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We previously described the first successful treatment of deep periocular and, subsequently, orbital infantile haemangiomas (IH) with topical transcutaneous timolol maleate 0.5% (TM 0.5%) alone as the first-line treatment in the acute proliferative phase in infancy. It is not known whether orbital IH with persistent proptosis in later years, untreated in infancy, would still respond to TM 0.5% treatment as well. To our best knowledge, we here present the first reports of the successful late treatment of persistent orbital IH with topical timolol maleate 0.5% applied to the skin overlying the orbital IH in two teenagers. Case 1 was an 11-year-old girl with proptosis measuring 4 mm before and 7 mm after Valsalva manoeuvre that diminished to 1 mm after topical treatment. Case 2 was a 10-year-old girl with 2 mm (before) and 4 mm proptosis (after Valsalva) that decreased to 0 mm proptosis with topical treatment. The time to resolution was 19 months (case 1) and 13 months (case 2). The treatment dose was 3 drops of TM 0.5% applied an average of 1.94 (case 1) and two times daily (case 2). In comparison to proptosis, resolution of periorbital swelling required less treatment time. There was no recurrence of either proptosis or periorbital swelling 1 year after stopping treatment in either case. The findings indicate that beta-blockers are effective not just in the proliferative but also in the late involutional phase in older children. No adverse clinical effects were noted throughout treatment in either case. The presence of increased proptosis with a Valsalva manoeuvre predicts a significant persistent vascular compartment in the orbital IH and may thus serve as a simple predictive clinical sign of likely treatment success. We recommend that a trial with this well-tolerated treatment form is considered in persistent cases of orbital IH, especially in the presence of enhanced proptosis with a Valsalva manoeuvre.

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“…Succinylcholine is a short-duration, muscle relaxant, and surgical anesthesia. Various studies have found that its anesthetic use is associated with hyperkalemia (increased potassium levels) (Ganigara, Ravishankar, Ramavakoda, & Nishtala, 2015;Thapa & Brull, 2000). In a comparative study of succinylcholine with vecuronium (another type of muscle-relaxant anesthesia), vecuronium was associated with a severe drop down in insulin and para-aminohippuric acid clearance rate, unlike succinylcholine.…”

Section: Muscle-relaxant Anesthesiamentioning

confidence: 99%

Renal effects of general anesthesia from old to recent studies

Alizadeh

Fard

2019

Journal Cellular Physiology

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Various types of anesthesia are being utilized to maintain physiologically secured surgical conditions. Nearly all categories of general anesthesia are characterized by various perioperative and postoperative complications. These shortcomings are important aspects that need to be considered by the anesthesiologist and surgeon before administration of these compounds. The renal effects of anesthesia play an important role in understanding possible systemic changes due to the fact that the kidney has a direct or indirect impact on nearly all the systems of the body. Various studies have been conducted to find out changes in renal parameters and its systemic effects upon administration of the anesthesia and its postoperative repercussions. Besides that, the impaired renal function might have an impact on the excretion of anesthetic metabolites, which can lead to long‐term dysfunction. Patients with a previous history of disease ought to be brought under consideration because these chemicals can ameliorate pre‐existent symptoms. This review is intended to discuss the early and latest studies based on the effects of general anesthesia on the renal system.

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Fatal hyperkalemia following succinylcholine administration in a child on oral propranolol

Cited by 11 publications

References 9 publications

Topical Timolol for Infantile Haemangioma of the Orbit

Topical Timolol for Infantile Haemangioma of the Orbit

Successful Late Treatment of Orbital Infantile Haemangiomas in Two Teenagers with Topical Transcutaneous Timolol Maleate 0.5% Alone

Renal effects of general anesthesia from old to recent studies

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