Unusual reaction to suxamethonium chloride.

Abstract

In the course of experimental surgery on a large number of six-month-old boars a most unusual reaction to the relaxant suxamethonium chloride was encountered in three animals. The affected pigs were litter mates, suggesting that this hitherto undescribed reaction is familial, resembling in this regard those cases of suxamethonium sensitivity associated with reduced levels of pseudocholinesterase (Lehmann and Ryan, 1956).In each pig premedication and induction of anaesthesia were entirely without incident. For premedication phencyclidine (phenylcyclohexylpiperidine) 30 mg. and atropine sulphate 1.8 mg. were given intravenously. Anaesthesia was induced by a halothane/oxygen mixture some 20 minutes after the premedication.CASE REPORTS Case 1.-After induction a 100-mg. dose of suxamethonium chloride was given intravenously. Instead of the fasciculation and mild contraction of the limb muscles ordinarily associated with suxamethonium administration, the injection was immediately followed by a violent convulsive seizure which was not followed by relaxation, though apnoea occurred. The jaw was forced open, a V12 cuffed endotracheal tube introduced, and ventilation with oxygen begun. Within 30 to 40 seconds of intubation the muscles of the neck, trunk, and limbs slowly contracted and became hard and fixed. At this point, though the circulation seemed to be unaffected, the skin showed patchy mottling similar to that seen in cadavers, and the appearances as a whole resembled those of an animal in rigor mortis. Another striking feature at this stage was brawny oedema affecting the soft tissues of the lower jaw. Gallamine triethiodide (280 mg.) was given intravenously but was without effect on the muscle contraction. Ventilation was continued and it was noted that the soda-lime canister became too hot to touch some four minutes after having been introduced into the circuit, suggesting that the C02 output was higher than normal. Despite the use of a mechanical ventilator, as compliance decreased ventilation became inadequate and the animal died of asphyxia. The pulse rate and volume remained normal until adequate ventilation could no longer be maintained.Case 2.-Here again the intravenous injection of 100 mg. of suxamethonium produced a convulsive seizure which was not followed by a period of relaxation. Despite difficulties due to vocalcord spasm, intubation was carried out and the lungs of the pig were ventilated with a halothane/oxygen mixture. The rectal temperature at this time was 102.8' F. (39.30 C.). Within five to seven minutes, when complete board-like rigidity identical with that described in the first pig had developed, the temperature was 109' F. (42.8' C.), and this eventually rose to 111°F. (43.9' C.). Ventilation became increasingly difficult owing to decreasing compliance, and the animal died. Cadaveric mottling and brawny oedema of the tissues of the lower jaw were again prominent features.Case 3.-The third litter mate was scheduled for operation a week after the two already described. At the time of its su...

Clinical, Electrophysiological and Pathological Studies on Malignant Hyperpyrexia

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