Posttetanic Potentiation and Fade in the Response to Tetanic and Train-of-Four Stimulation During Succinylcholine-Induced Block

Abstract

Posttetanic potentiation and fade in response to train-of-four and tetanic stimuli are characteristics of neuromuscular block after bolus administration of different doses of succinylcholine. We also conclude that some characteristics of a Phase II block are evident from an initial dose (i.e., as small as 0.3 mg/kg) of succinylcholine.

Reversal of Profound Neuromuscular Block by Sugammadex Administered Three Minutes after Rocuronium

“…9 The observed times to spontaneous recovery of T 1 to 10% and to 90% from succinylcholine-induced block are consistent with previous reports for the same dose of succinylcholine (1 mg/kg). 27,28 While lower doses of succinylcholine may also provide adequate conditions for intubation, 28 -30 higher doses are reported to provide excellent intubation conditions. 30 Although our study may be limited by the fact that the rocuronium-sugammadex group was compared against only one dose of succinylcholine (1 mg/kg), this dose of succinylcholine is the most commonly used dose for rapid-sequence induction 30 and was thus considered appropriate for this study.…”

Monitoring and Antagonism of Neuromuscular Blockade: Problems with Succinylcholine

“…De Jong and Freund showed that, after succinylcholine administration, fade occurred during tetanic stimulation. 4 Naguib et al 5 also showed that boluses of succinylcholine (0.1 and 1.0 mg/kg) caused significant train-of-four fade (40 and 68%, respectively), tetanic fade and posttetanic potentiation.…”

“…Mutations of the gene may result in heterozygous and homozygous atypical enzymes, 7 resulting in prolonged neuromuscular blockade after succinylcholine administration ( i.e ., 10 to 30 min and 40 to 200 min, respectively). 2 Therefore, succinylcholine may cause fade in phase 1 block, 2,5 in phase 2 block, 2,6,8 or during mixed phase 1 and 2 block (acetylcholine receptor desensitization by succinylcholine occurring in parallel with depolarization). 5,9…”

“…2 Therefore, succinylcholine may cause fade in phase 1 block, 2,5 in phase 2 block, 2,6,8 or during mixed phase 1 and 2 block (acetylcholine receptor desensitization by succinylcholine occurring in parallel with depolarization). 5,9…”

Progress towards a standard of quantitative twitch monitoring

“…Indeed, monitoring succinylcholine blockade seems to us a reasonable proposal. Incidentally, it turns out that succinylcholine causes fade in the TOF stimulation responses after normal doses for tracheal intubation, despite the popular notion that succinylcholine only causes diminution of twitch height, but not fade .…”