Suxamethonium Associated Hypertonicity and Cardiac Arrest in Unsuspected Pseudohypertrophic Muscular Dystrophy

Linter, S.P.K.; Thomas, Preenumol; Withington, P. S.; Hall, Matthew

doi:10.1093/bja/54.12.1331

Cited by 42 publications

(11 citation statements)

References 1 publication

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“…In fact, hyperkalemia-related cardiac arrest has been reported following its administration. 20,[32][33][34][35][36][37][38][39][40][41][42][43][44][45] A common challenge facing EPs is to identify those patients who may be hyperkalemic prior to intubation. A history of renal failure and the presence of an atrioventricular shunt are obvious clues.…”

Section: Discussionmentioning

confidence: 99%

“…Other clinical conditions have also been reported to predispose certain patients to hyperkalemia-related cardiac dysrhythmias, even if their initial serum potassium is within normal limits. These conditions include paraplegia and denervation syndromes, [32][33][34][35]41,45 extensive nonacute burns, 36,46 muscular dystrophy, [37][38][39][40] severe infections, 20,42 severe acidosis, 43 hypokalemia, 44 and chronic digitalis use. 47 These patients can experience an exaggerated hyperkalemic response to succinylcholine, with levels sometimes rising as much as 5.7 mmol/L 20 to a total of 13.6 mmol/L.…”

Section: Discussionmentioning

confidence: 99%

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A Comparison of Succinylcholine and Rocuronium for Rapid‐sequence Intubation of Emergency Department Patients

Laurin

Sakles

Panacek

et al. 2000

Academic Emergency Medicine

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Abstract. Objective: To compare rocuronium and succinylcholine for rapid-sequence intubation (RSI) in the emergency department (ED). Methods: A oneyear prospective cohort comparison study was performed using a data collection form completed at the time of intubation. Data collected included the reason for the neuromuscular-blocking agent (NMBA) chosen, the time to onset of paralysis, and any complications encountered. Three ten-point numerical descriptor scales recorded the degree of body movement, vocal cord movement, and the physician's overall satisfaction with the extent of paralysis. Results: Succinylcholine was used in 382 patients and rocuronium was used in 138 (26% of all RSI) patients. The mean (Ϯ SD) times of onset of succinylcholine and rocuronium were 39 Ϯ 13 sec and 44 Ϯ 20 sec, respectively (p = 0.04). No patient desaturated and required assisted ventilations while waiting for paralysis to occur. Types of body movements were similar with the two agents, but less frequent with succinylcholine (median = 10, mean = 9.5 Ϯ 1.1) than rocuronium (median = 10, mean = 9.1 Ϯ 1.5) (p = 0.01). Vocal cord movements were similar for succinylcholine (median = 10, mean = 9.2 Ϯ 1.6) and rocuronium (median = 9, mean = 9.0 Ϯ 1.6) (p = 0.15). The physician's overall satisfaction with the extent of paralysis was also higher for succinylcholine (median = 10, mean = 9.4 Ϯ 1.3) than rocuronium (median = 10, mean = 8.8 Ϯ 2.0) (p < 0.01). Only one complication, widening of the QRS complex secondary to succinylcholine use in a patient with unsuspected hyperkalemia, could be attributed to the choice of NMBA. Conclusions: Both succinylcholine and rocuronium produced fast and reliable paralysis for RSI. Although succinylcholine had a faster onset and provided more relaxation, the difference had no clinical significance. Approximately a fourth of ED RSI patients qualified for use of rocuronium using these high-risk criteria. Key words: rapid-sequence intubation; tracheal intubation; neuromuscular-blocking agents; succinylcholine; rocuronium. ACADEMIC EMERGENCY MEDICINE 2000; 7:1362-1369 R APID-sequence intubation (RSI) is a lifesaving procedure developed to quickly and safely secure the airway of a critically ill or injured patient. In the emergency department (ED), RSI is often chosen over other intubation techniques because the simultaneous onset of deep sedation and paralysis, followed rapidly by tracheal intubation, minimizes the risk of pulmonary aspiration of gastric contents. Rapid-sequence intubation has therefore become the technique of choice for the intubation of patients at risk of having full stomachs, such as ED patients. Indeed, several recent studies have shown RSI as the most common method to achieve airway control in the ED.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Comparison of Succinylcholine and Rocuronium for Rapid‐sequence Intubation of Emergency Department Patients

Laurin

Sakles

Panacek

et al. 2000

Academic Emergency Medicine

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“…Unanticipated cardiac arrest caused by succinylcholineinduced rhabdomyolysis and hyperkalemia in the presence of an undiagnosed myopathy can occur [41][42][43][44]. When faced with sudden, life-threatening arrhythmias or cardiac arrest following succinylcholine administration at induction of anaesthesia in paediatric patients, especially males, occult myopathy and hyperkalemia should be considered in the differential diagnosis.…”

Section: Mechanisms Of Cardiac Arrestmentioning

confidence: 99%

Imaging techniques for regional nerve blockade and vascular cannulation in children

Lee

Mason²

2006

Current Opinion in Anaesthesiology

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Outcomes for paediatric patients undergoing anaesthesia have improved over the years as a result of advances in monitoring and equipment, safer and more easily titratable anaesthetic agents, and possibly the practice of subspecialization. Preventable complications still, however, occur. An awareness of frequently encountered complications during paediatric anaesthesia may lead to the earlier detection and treatment of perioperative problems, leading to better outcomes.

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“…22 Despite several case reports of children with DMD that seemingly develop MH, 23 no definitive genetic link between DMD and malignant hyperthermia has been found, and many patients with DMD have been exposed to general anesthetic agents without incident. Existing case reports of anesthetic-related complications in DMD patients represent inhalational anesthetic-induced rhabdomyolysis, [24][25][26][27][28][29] succinylcholine-induced hyperkalemia, [30][31][32] or a coincidental inheritance of both mutations. Additional confusion results from the fact that rhabdomyolysis resulting from exposure to inhalational anesthetics may also be associated with hypermetabolism, a hallmark of MH.…”

Section: Muscular Dystrophiesmentioning

confidence: 99%

MH-associated diseases: who really needs a non-triggering technique?

Litman

2007

Seminars in Anesthesia, Perioperative Medicine and Pain

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Suxamethonium Associated Hypertonicity and Cardiac Arrest in Unsuspected Pseudohypertrophic Muscular Dystrophy

Abstract: We report a case that showed many of the features of the malignant hyperpyrexia syndrome following suxamethonium administration, in an unsuspected case of pseudohypertrophic (Duchenne) muscular dystrophy

Cited by 42 publications

References 1 publication

A Comparison of Succinylcholine and Rocuronium for Rapid‐sequence Intubation of Emergency Department Patients

A Comparison of Succinylcholine and Rocuronium for Rapid‐sequence Intubation of Emergency Department Patients

Imaging techniques for regional nerve blockade and vascular cannulation in children

MH-associated diseases: who really needs a non-triggering technique?

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