The optimal succinylcholine dose for intubating emergency patients: retrospective comparative study

Abstract

BackgroundSuccinylcholine remains the drug of choice for satisfactory rapid-sequence tracheal intubation. It is not clear from the literature why the 1 mg/kg dose of succinylcholine has been traditionally used. The effective dose (ED95) of succinylcholine is less than 0.3 mg/kg. The dose of 1 mg/kg represents 3.5 to 4 times the ED95.ObjectivesTo compare the effect of the traditionally used 1 mg/kg of succinylcholine with lower doses of 0.6 mg/kg and 0.45 mg/kg on intubation condition regarding the onset time, duration of action, duration of abdominal fasciculation, and the intubation grading.MethodsThis retrospective comparative study was carried into three groups of ASA III & IV (American Society of Anesthesiologist's Physical Status III and IV) non-prepared emergency patients who were intubated at emergency department of Hamad General Hospital, Doha, Qatar during January 1st 2007 to August 31, 2010. The Institutional Research Board (IRB) approval was obtained. This study was limited to 88 patients who received fentanyl 1µg/kg followed by etomidate 0.3 mg/kg intravenously as induction agents and succinylcholine as a muscle relaxant agent in doses of 0.45 mg/kg, 0.6 mg/kg, or 1 mg/kg.ResultsIncreasing the succinylcholine dosage shortened the onset time, prolonged the duration of action, and prolonged the duration of abdominal fasciculation significantly (P<.001). Tracheal intubation was 100% successful in the three groups of patients.ConclusionSuccinylcholine dose of 0.45 mg/kg provides an optimal intubation condition in ASA III & IV emergency non-prepared patients. Duration of action of succinylcholine is dose dependent; reducing the dose allows a more rapid return of spontaneous respiration and airway reflexes.

Optimal anesthetic regimen for ambulatory laser microlaryngeal surgery

“…However, continuous succinylcholine infusion can increase the risk of phase II neuromuscular block even during short surgical procedures (less than 90 min) . Increased succinylcholine dose has also been reported to prolong the duration of abdominal fasciculation . Other studies have reported the advantages of a reduced succinylcholine dose, as it minimizes the incidence of malignant hyperthermia, myalgia, masseter spasm, rhabdomyolysis, and hyperkalemia .…”

“…Increased succinylcholine dose has also been reported to prolong the duration of abdominal fasciculation . Other studies have reported the advantages of a reduced succinylcholine dose, as it minimizes the incidence of malignant hyperthermia, myalgia, masseter spasm, rhabdomyolysis, and hyperkalemia . We therefore decided to use a single bolus of succinylcholine with cisatracurium, a nondepolarizing NMBA with intermediate duration, instead of a continuous infusion of succinylcholine.…”

Rapid sequence induction/intubation controversies

“…They concluded that the use of succinylcholine significantly produced more acceptable intubation condition compared with saline, but there was no significant differences between the groups of different succinylcholine doses (92%, 94%, and 98% of patients achieved acceptable intubation condition after given 0.3, 0.5, 1 mg/kgBW of succinylcholine, respectively) 40 . Another experimental study comparing the use of succinylcholine 0.45, 0.6, and 1 mg/kgBW among patients requiring emergency intubation concluded that intubation was 100% successful in all three groups 41 . Increased dose of succinylcholine, however, was associated with faster onset, longer duration of action, as well as more obvious abdominal fasciculation 41 .…”

“…41 Increased dose of succinylcholine, however, was associated with faster onset, longer duration of action, as well as more obvious abdominal fasciculation. 41 Similarly, a prospective, randomized, double-blind study involving 180 patients with a suspected difficult airway studied the effects of succinylcholine 0.3, 0.6, and 1 mg/kgBW for tracheal intubation reported that good and excellent intubation condition were achieved in 80%, 91.7%, and 93.3% of patients given succinylcholine 0.3, 0.6, and 1 mg/kgBW, respectively. Therefore, succinylcholine 0.6 mg/kgBW produced similar intubation condition to 1 mg/kgBW; however, recovery of spontaneous respiration after succinylcholine 1 mg/ kgBW was significantly longer.…”

“…Another experimental study comparing the use of succinylcholine 0.45, 0.6, and 1 mg/kgBW among patients requiring emergency intubation concluded that intubation was 100% successful in all three groups 41 . Increased dose of succinylcholine, however, was associated with faster onset, longer duration of action, as well as more obvious abdominal fasciculation 41 . Similarly, a prospective, randomized, double‐blind study involving 180 patients with a suspected difficult airway studied the effects of succinylcholine 0.3, 0.6, and 1 mg/kgBW for tracheal intubation reported that good and excellent intubation condition were achieved in 80%, 91.7%, and 93.3% of patients given succinylcholine 0.3, 0.6, and 1 mg/kgBW, respectively.…”