Inadvertent injection of succinylcholine as an epidural test dose

Abstract

Background and objectives: Epidural action of neuromuscular blocking agents could be explained under the light of their physicochemical characteristics and epidural space properties. In the literature there are few cases of accidental neuromuscular agent's epidural administration, manifesting mainly with neuromuscular blockade institution or fasciculations. Case report: We report a case of accidental succinylcholine administration as an epidural test dose, in a female patient undergoing scheduled laparotomy, under combined general and epidural anesthesia. Approximately 2 min after the succinylcholine injection the patient complained for shortness of breath, while mild fasciculations appeared in her trunk and face, managed by immediate general anesthesia institution. With the exception of a relatively longer duration of neuromuscular blockade compared with intravenous administration, no neurological or cardiovascular sequelae or other symptoms of local or systemic toxicity were observed. Conclusions: Oral administration of diazepam seems to lessen the adverse effects from accidental epidural administration of succinylcholine. The meticulous and discriminative labeling of syringes, as well as keeping persistent cautions during all anesthesia procedures remains of crucial importance. Injeção inadvertida de succinilcolina como uma dose teste epiduralResumo Justificativa e objetivos: A ação epidural de agentes bloqueadores neuromusculares pode ser explicadas à luz de suas características físico-químicas e propriedades do espaço epidural. Na

Management of Accidental Succinylcholine Ingestion: Navigating Uncharted Waters

“…They reported shortness of breath, dysarthria, and fasciculations in the thoracic part of the trunk, upper extremities, and face two minutes after accidental epidural administration of 100 mg of succinylcholine, which was managed with the induction of general anaesthesia. Pourzitaki et al reported the administration of 125 mg of Sux during combined spinal and epidural anesthesia without any neurological or cardiovascular complications during the postoperative period [ 7 ]. They reported that diazepam taken orally can lessen the adverse effects of accidental epidural administration of Sux.…”