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PubMed1992

Intraocular pressure changes in response to endotracheal intubation facilitated by atracurium or succinylcholine with or without lidocaine.

Changes in intraocular pressure (IOP) and hemodynamics (SP, DP and HR) were measured in 105 patients ASA I and II randomly assigned into seven equal and comparable groups (A to G) during induction of anesthesia and endotracheal intubation facilitated either by succinylcholine or atracurium with or without lidocaine. IOP decreased significantly (p less than 0.01) after induction of anesthesia with thiopentone in all the groups. While atracurium with or without lidocaine did not affect IOP following complete suppression of train-of-four (groups A, B, and C), succinylcholine per se or in combination with lidocaine (groups F and G) significantly (p less than 0.01) increased IOP after induction with thiopentone but not exceeding the baseline IOP level. IOP was significantly elevated (p less than 0.01) immediately after endotracheal intubation in all the groups when compared to IOP following thiopentone administration. In those patients given atracurium (groups A to E), IOP increased (p less than 0.05) in response to endotracheal intubation above the baseline level only in group B where atracurium was divided into a priming and intubating doses. However, the priming dose did not have any significant effect on the onset time of complete twitch suppression of train-of-four and did not affect the intubation conditions compared with the uniformly excellent conditions found with atracurium over an equivalent bolus dose of the relaxant. In patients who received succinylcholine only (group F), IOP immediately after endotracheal intubation was significantly greater (p less than 0.01) as compared to the baseline and did not return to the baseline level until 3 minutes after endotracheal intubation. The use of lidocaine in combination with atracurium (group D) or succinylcholine (group G) for a rapid sequence intubation did not affect IOP following endotracheal intubation. However, atracurium when used in a rapid sequence intubation could not produce similar intubation conditions when compared with succinylcholine. Consequently, we cannot endorse atracurium as an alternative to succinylcholine for patients with penetrated eye injuries and full stomach requiring rapid sequence intubations. In this context, the role of IV lidocaine in mitigating or preventing the systemic and ocular reactions and especially the acute increase in IOP associated with endotracheal intubation should be emphasized.

Anesthesia, Endotracheal↗

PubMed1991

Enhancing effect by nicotinic acetylcholine receptor channel blockers, including beta-eudesmol, on succinylcholine-induced inhibition of twitch tension and intracellular Ca++ in mouse diaphragm muscle.

To elucidate the mechanism of neuromuscular block by succinylcholine, nerve-evoked changes in intracellular Ca(++)-aequorin luminescence and twitch tension were measured simultaneously in the presence of several different types of blockers for the nicotinic acetylcholine receptor channel. Mouse diaphragm muscles were pretreated for 30 to 60 min with 3 to 40 microM bupivacaine, chlorpromazine, phencyclidine and beta-eudesmol. The effects of these noncompetitive blockers on the succinylcholine-induced response were also compared with those for pancuronium. These channel blockers potentiated (2- to 10-fold) both the blocking effects on intracellular Ca++ and twitch tension of succinylcholine (13-100 microM), but not the pancuronium (0.3-1.1 microM)-induced block. These channel blockers also suppressed succinylcholine (1.3-5 microM)-induced enhancement of evoked Ca++ transients. On the other hand, the channel blockers inhibited the succinylcholine (2.5-100 microM)-induced increase in basal Ca++ transients. These results suggest that neuromuscular block induced by succinylcholine is mainly due to desensitization of the nicotinic acetylcholine receptor.

Aequorin↗

PubMed1988

Length-tension curves of human eye muscles during succinylcholine-induced contraction.

We have made intraoperative, continuous-registration, length-tension diagrams of detached eye muscles in 80 strabismus patients under general anaesthesia. In 47 of these we repeated the measurements after contraction evoked by succinylcholine chloride. In contracting horizontal and vertical rectus muscles, we found a linear relation between length and tension. In contracting oblique muscles, however, the relation between length and tension was frequently nonlinear. In superior oblique palsies, the superior oblique was found to be stiff after elongation and before injection of succinylcholine, and it did not contract after injection of succinylcholine. The ipsilateral inferior oblique did contract after injection of succinylcholine, but with a higher spring constant than usual (ie, contracture of the ipsilateral antagonist). In three cases the superior oblique contracted vividly after administration of succinylcholine despite the presence of excyclotropia, stereopsis, torticollis (two cases) and a hypertropia that increased in adduction, in down-gaze, in adduction and down-gaze and on ipsilateral head-tilt. In a case of general fibrosis syndrom we found almost normally contracting vertical recti, which is compatible only with a supranuclear or misdirectional cause. These cases demonstrate the usefulness of the assessment of the length-tension diagram of an eye muscle during surgery, before and during contraction evoked by succinylcholine chloride.

Humans↗

PubMed1987

Mechanisms of succinylcholine-induced arrhythmias in hypoxic or hypoxic:hypercarbic dogs.

To evaluate the effects of succinylcholine on cardiac arrhythmias and serum levels of potassium and catecholamines, dogs with hypoxia alone and with hypoxia and hypercarbia were studied during anesthesia with halothane or enflurane. After the injection of succinylcholine (0.3 mg/kg), cardiac arrhythmias occurred in all halothane:hypoxia dogs and in 70% of dogs given halothane during hypoxia:hypercarbia. No dogs given enflurane anesthesia developed arrhythmias. Serum potassium levels increased significantly 3 and 5 min after succinylcholine in all groups. Serum epinephrine levels increased in the halothane-hypoxia:hypercarbia and enflurane:hypoxia groups and, after the injection of succinylcholine, epinephrine levels increased further in dogs in the halothane:control, halothane:hypoxia, halothane-hypoxia:hypercarbia, enflurane:hypoxia, and enflurane-hypoxia:hypercarbia groups. Norepinephrine levels increased with enflurane-hypoxia:hypercarbia and after the succinylcholine in the halothane:hypoxia, halothane-hypoxia:hypercarbia, and enflurane-hypoxia:hypercarbia groups. The results suggest that succinylcholine induces arrhythmias by sympathetic stimulation and that halothane sensitizes the myocardium to arrhythmias at the same levels of serum catecholamines and potassium in the presence of hypoxia or hypoxia:hypercarbia more than does enflurane.

Anesthesia, Inhalation↗

PubMed1980

Does diazepam pretreatment prevent succinylcholine-induced fasciculations?--a double-blind comparison of diazepam and tubocurarine pretreatments.

To determine the effectiveness of diazepam pretreatment in preventing succinylcholine-induced fasciculations, 61 surgical patients were randomly allocated into three groups receiving either diazepam (0.05 mg/kg), d-tubocurarine (0.05 mg/kg) or saline in a double-blind fashion. Following the induction of anesthesia with fentanyl and thiopental, a bolus dose of succinylcholine (1 mg/kg was injected 5 minutes after the pretreatment drugs. Resulting fasciculations were then graded visually. Responses to electrical simulation of the ulnar nerve, somatic motor responses to laryngoscopy and endotracheal intubation, and changes in serum levels of potassium were also evaluated. Diazepam had no effect on frequency or intensity of succinylcholine fasciculations. Fasciculations were observed in 90% of the patients given placebo injections and in 95% of those given diazepam, but in only 16% of those given tubocurarine. Tubocurarine prolonged the onset and shortened the duration of the succinylcholine block and thus made intubation more difficult. Diazepam accelerated onset, but had no effect on duration of succinylcholine block. The twitch response following ulnar nerve stimulation disappeared after 84 seconds (p < 0.01 vs placebo) in patients given diazepam after 115 seconds in patients given tubocurarine, and after 106 seconds in those given placebo injections. The increase in serum potassium after succinylcholine was prevented by pretreatment with d-tubocurarine but not by diazepam.

Clinical Trials as Topic↗

PubMed1990

Dose-related effects of succinylcholine on the adductor pollicis and masseter muscles in children.

This study was performed to determine the effects of various doses of succinylcholine on resting tension and evoked twitch height at the masseter and adductor pollicis muscles in children. Twenty patients, aged 3-10 yr, ASA physical status I or II, were randomly assigned to receive succinylcholine 0.15, 0.25, 0.50 or 1.00 mg.kg-1, during halothane-nitrous oxide anaesthesia. Supramaximal train-of-four stimulation was applied simultaneously to the ulnar nerve and the nerve to the masseter. Transducers recorded force at the jaw and the thumb. Maximum blockade of the first twitch (T1) and maximum resting tension change were measured. Potency of succinylcholine at the two muscles was estimated by linear regression of the logit transformation of T1 versus log dose. The relationship between resting tension change and log dose was established by linear regression. The masseter muscle was more sensitive to succinylcholine than the adductor pollicis with an ED95 of 0.28 +/- 0.02 (mean +/- SEM) vs 0.44 +/- 0.05 mg.kg-1 (P less than 0.05). Onset of neuromuscular blockade was faster at the masseter, and recovery occurred simultaneously in both muscles. A dose-related increase in resting tension was observed in both muscles, but its magnitude was five times greater at the masseter. With succinylcholine, 1 mg.kg-1, this increase was 51.6 +/- 16.8 g at the masseter and 9.1 +/- 2.3 g at the adductor pollicis. Tension returned to baseline within 1-2 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗

PubMed1982

Effect of atropine on bradydysrhythmias induced by succinylcholine following pretreatment with D-tubocurarine.

This study was designed to compare the effectiveness of pretreatment with the combination of d-tubocurarine and atropine with d-tubocurarine alone in preventing changes in cardiac rate and rhythm following repeated administration of succinylcholine. Sixty subjects were randomly divided into three groups of twenty. Group one received d-tubocurarine 0.04 mg.kg-1 and atropine 0.01 mg.kg-1, and group two d-tubocurarine 0.04 mg.kg-1 only, given three minutes before induction of anaesthesia. Group three received no pretreatment. Immediately following thiopentone induction succinylcholine 1 mg.kg-1 was given to all patients. A further dose of succinylcholine 1 mg.kg-1 was given to patients in the pretreatment groups following recovery of neuro-muscular function. Both pretreatment groups showed a small statistically significant fall in mean heart rate after the second dose of succinylcholine. One patient in each pretreatment group showed a fall in heart rate to less than 50 beats min-1; two patients in the group who received both d-tubocurarine and atropine, and three patients in the d-tubocurarine only group, showed a fall in heart rate of 25 per cent or more. It is concluded that the addition of atropine may be unnecessary for prevention of succinylcholine-induced bradydysrhythmias when d-tubocurarine pretreatment is given.

Anesthesia, General↗

PubMed1981

The influence of fazadinium on the potassium efflux produced by succinylcholine.

Succinylcholine-induced potassium efflux was studied in two groups of healthy adult patients presenting for elective surgery. One group (Group 1) of 12 patients received alfathesin induction followed by succinylcholine. The other group (Group 2) of 12 patients were pre-treated with fazadinium 0.075 mg . kg-1 about three minutes before administration of alfathesin and succinylcholine. Serial blood samples were taken pre-induction, post-induction and after succinylcholine for estimation of plasma potassium. The results show that pre-treatment with fazadinium 0.075 mg . kg-1 was effective in preventing succinylcholine-induced potassium efflux.

Adult↗

PubMed1986

Comparison of the effects of succinylcholine and atracurium on intracranial pressure in monkeys with intracranial hypertension.

The effects of succinylcholine (1.5 mg X kg-1 IV) administered five minutes after a defasciculating dose of curare (0.05 mg X kg-1 IV), were compared with the effects of atracurium (0.5 mg X kg-1 IV) on intracranial pressure (ICP) in 13 cynomolgus monkeys with intracranial hypertension (ICP approximately 25 mmHg). Neither succinylcholine nor atracurium increased ICP during general anaesthesia with 60 per cent N2O/O2, 0.5-1 per cent halothane. During a rapid sequence induction and intubation with thiopentone 5 mg X kg-1 IV, ICP increased equally with intubation following both atracurium (25 +/- 1 to 32 +/- 2 mmHg) and succinylcholine (25 +/- 1 to 31 +/- 2 mmHg) (p less than 0.05). Intubation was also associated with significant increases in PaCO2, CVP and MAP. We conclude that in this primate model of intracranial hypertension, neither atracurium nor succinylcholine (when given following a defasciculating dose of curare) elevates ICP. In terms of the elevation of ICP associated with intubation, atracurium was found to offer no advantage over succinylcholine.

Anesthesia, Endotracheal↗

PubMed1997

Tacrine does not alter the potency of succinylcholine in the rat.

PURPOSE: Tacrine is a cholinesterase inhibitor used to manage Alzheimer's dementia. Given iv, it prolongs succinylcholine blockade in humans but the effects of chronic oral tacrine are not known. METHODS: Groups of adult rats were given 2.5 mg.kg-1 tacrine (chronic groups) or l ml saline (control) twice daily by gavage for one, two, four or eight weeks. An additional (acute) group received 2.5 mg.kg-1 tacrine iv. Twelve to 18 hr after the last gavage of tacrine or saline, and -20 min after iv tacrine, cumulative dose-response curves of succinylcholine were determined in the tibialis and soleus muscles in anaesthetized, ventilated rats during monitoring of evoked twitch response to indirect (nerve) train-of-four stimulation. RESULTS: The ED50 and ED95 of succinylcholine in control rats were (mean +/- SD) 204 +/- 41 and 382 +/- 96 micrograms.kg-1, respectively in the tibialis muscle, and 280 +/- 52 and 629 +/- 168 micrograms.kg-1 in the soleus muscle (P < 0.05 between muscles). In the acute and chronic tacrine groups, the mean ED50 and ED95 ranged from 166-197 and 277-396 micrograms.kg-1., respectively, in the tibialis muscle, and 248-333 and 546-667 micrograms.kg-1, in the soleus muscle. Dose responses did not differ among acute and chronic tacrine groups and the control group. CONCLUSION: Chronic oral tacrine does not alter muscle response to succinylcholine in the rat. This may not apply to Alzheimer patients receiving chronic tacrine since the interaction between acute tacrine and succinylcholine in the rat differs from that in humans.

Administration, Oral↗

PubMed1999

Low dose mivacurium is less effective than succinylcholine in electroconvulsive therapy.

PURPOSE: To compare the efficacy of low dose (LD) mivacurium (0.08 mg.kg-1) with LD succinylcholine (0.5 mg.kg-1) in modifying seizure activity during electroconvulsive therapy (ECT). Partial muscle relaxation is used in ECT to prevent violent muscle contractions. Current practice is to use LD succinylcholine which has several undesirable side effects. METHOD: Sixteen depressed, but otherwise healthy, patients, aged 27-67 yr were studied. In a randomized, double-blind, cross-over study, either LD mivacurium or LD succinylcholine was given at consecutive ECTs 120 and 30 sec respectively before inducing ECT. Neuromuscular blockade following mivacurium was not reversed. Seizure modification was scored--0 = no seizure activity, 1 = over-modified, 2 = desired level, 3 = under-modified, 4 = unmodified. Duration of seizures, time to first breath and adequate ventilation, ability to protrude tongue and sustain hand grip for five seconds were recorded. Paired t-tests and Wilcoxon matched pairs test were used to compare data. P < 0.05 was considered significant. RESULTS: Seizure modification was better (mean (range)) after succinylcholine 2.06(1-3) than after mivacurium 2.56(2-4) (P < 0.05). Mivacurium was unsatisfactory in eight cases compared with two cases after succinylcholine. The study was terminated early because of unsatisfactory seizure control. Clinical assessments of recovery from both relaxants were similar. CONCLUSION: Low dose mivacurium is unsuitable for use in ECT.

Adult↗

PubMed1998

Rocuronium is the best non-depolarizing relaxant to prevent succinylcholine fasciculations and myalgia.

PURPOSE: To determine which non-depolarizing relaxant among d-tubocurarine, vecuronium, atracurium, mivacurium and rocuronium prevented muscular fasciculations and myalgia following succinylcholine. METHODS: In this double blind randomized study, 120 female patients scheduled for laparoscopic procedures were studied. They were divided into six groups of 20 according to the non-depolarizing pretreatment used: NaCl 0.9% (control), 0.05 mg.kg-1 d-tubocurarine, 0.01 mg.kg-1 vecuronium, 0.05 mg.kg-1 atracurium, 0.02 mg.kg-1 mivacurium and 0.06 mg.kg-1 rocuronium. Four minutes after the pretreatment, 1.5 mg.kg-1 succinylcholine was injected. Side effects of the pretreatment, the presence and magnitude of fasciculations, the ease of tracheal intubation, myalgia 1, 24 and 48 hr after surgery were observed. A Puritan Bennett Datex 221 NMT Relaxograph monitor was used to evaluate the neuromuscular block. RESULTS: Muscle fasciculations were observed in 19 of the 20 patients in the control group and in 3 of the 20 patients in the rocuronium group, the best of the pretreatments in that aspect. Four patients in the mivacurium group were unable to sustain more than four seconds head-lift after pretreatment (P < 0.05). Tracheal intubation conditions were better and the onset of block was faster and longer after succinylcholine in the control group (P < 0.05). Myalgias were present in 71% of the patients 24 hr postoperatively and the frequency was not different among the groups. CONCLUSION: Among the pretreatments tested, 0.06 mg.kg-1 rocuronium was the best to prevent muscular fasciculations following succinylcholine injection. In the population studied, pretreatment did not prevent postoperative myalgia. Succinylcholine 1.5 mg.kg-1 was more effective without a non-depolarizing pretreatment.

Adult↗

PubMed1983

Neostigmine antagonism of succinylcholine phase II block: a comparison with pancuronium.

To assess the efficacy of neostigmine antagonism of succinylcholine phase II block, succinylcholine infusions were given to 17 patients for durations varying from 44 to 192 minutes. A control group (17 patients) received a pancuronium infusion for similar times. Ninety per cent neuromuscular block was maintained in these two groups by adjustment of the infusion rates and, in a third group, with intermittent doses of pancuronium. Neuromuscular transmission was monitored with train-of-four stimulation every 12 seconds and anaesthesia was maintained with N2O-O2-enflurane. Ten minutes after the infusion was stopped, atropine and neostigmine were given to all patients who received pancuronium and to 11 patients in the succinylcholine group whose train-of-four ratio (T4/T1) was less than 0.7. During the subsequent 15 minutes, recovery was more rapid in the succinylcholine group than in either the pancuronium-infusion or pancuronium-bolus groups. It is concluded that succinylcholine-induced phase II block can be safely and rapidly antagonized with neostigmine.

Adult↗

PubMed1994

[Prolonged neuromuscular blockade. Different antagonistic effects following successive exposure to vecuronium and succinylcholine in a patient with atypical plasma cholinesterase].

An 81-year-old patient had prolonged competitive neuromuscular blockade with train-of-four ratios of 0.1 and 0.5, respectively, after two successive anaesthesia procedures (enflurane-N2O/O2; vecuronium-succinylcholine-sequence) for transurethral prostate resection. Although antagonism with neostigmine was promptly successful after the first, 65-min period of anaesthesia (1.5 mg vecuronium for precurarization, 100 mg succinylcholine for intubation, 3 mg vecuronium), repetitive and chronologically staggered administration of neostigmine after the second, 30-min period of anaesthesia (1 mg vecuronium for precurarization, 100 mg succinylcholine for intubation) had hardly any effect, so that the patient had to be ventilated mechanically for a total of 4.5 h. Laboratory analysis revealed homozygous, atypical, plasma cholinesterase (790 U/l; dibucaine number 23; genotype E1aE1a). This retrospectively confirmed a succinylcholine-induced phase II block in both instances, as had already been suspected following the second anaesthetic procedure. The degree of block transformation, and thus the available time, are decisive in explaining the diverse effects of antagonism here. It must be assumed that a complete phase II block developed after the first succinylcholine exposure owing to the longer duration of anaesthesia; the purely competitive component (train-of-four ratio 0.1) was easily antagonized by neostigmine. At the time of the attempted antagonism after the second, shorter period of anaesthesia, however, block transformation was still incomplete (train-of-four ratio 0.5). The administration of neostigmine therefore rather intensified the depolarization segment of the mixed block, so that repeated attempts at antagonism then inhibited any further block transformation.

Aged↗

PubMedDate not supplied

Midazolam pretreatment does not ameliorate myoglobinemia or the clinical side effects of succinylcholine.

STUDY OBJECTIVE: To determine whether the levels of serum myoglobin and the occurrence of fasciculations and postoperative symptoms following a single dose of succinylcholine are modified by the prior administration of midazolam. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Outpatient surgical service of a university hospital. PATIENTS: 69 ASA physical status I and II healthy, adult female outpatients undergoing laparoscopy (for diagnosis or tubal ligation) with general anesthesia that included succinylcholine. INTERVENTIONS: Patients received pretreatment of either a saline placebo (Group 1, n = 31) or intravenous midazolam 0.03 mg/kg (Group 2, n = 38) 5 minutes before succinylcholine. MEASUREMENTS AND MAIN RESULTS: Serum myoglobin prior to pretreatment and at 5 (t5) and 30 (t30) minutes after succinylcholine was determined by radioimmunoassay. Pain was assessed by telephone interview 24 to 36 hours postoperatively. Baseline myoglobin levels ranged from 14 to 69 ng/ml; the 5- and 30-minute samples varied widely (range, 16 to 900 ng/ml). The rise was 3 or more SDs above the baseline mean in 23% and 42% of Group 1 at t5 and t30, respectively, and in 21% and 35% of Group 2 at t5 and t30, respectively. The differences between groups were not significant. The frequency of fasciculations (77% in Group 1, 87% in Group 2), postoperative sore throat (64% in Group 1, 57% in Group 2), and myalgias (44% in Group 1, 51% in Group 2) also was not significantly different between groups. CONCLUSIONS: Midazolam had no effect on myoglobin level or postoperative symptoms following succinylcholine.

Adult↗

PubMed2000

Rocuronium versus succinylcholine-atracurium for tracheal intubation and maintenance relaxation during propofol anesthesia.

STUDY OBJECTIVES: To compare the onset and offset time (clinical duration), and intubating conditions obtained with rocuronium bromide 0.6 mg/kg and succinylcholine 1.0 mg/kg after induction with propofol and fentanyl; and to compare rocuronium with atracurium for maintenance during propofol anesthesia. DESIGN: Prospective, open-label, parallel group comparative, randomized study. SETTING: Operating rooms of a university hospital. PATIENTS: 30 ASA physical status I and II adult patients scheduled for elective surgeries with general anesthesia. INTERVENTIONS: Patients premedicated with midazolam 2 mg were anesthetized with fentanyl 2 microg/kg followed by propofol 2.5 mg/kg and muscle relaxants. Group 1 (n = 15) received succinylcholine 1.5 mg/kg and Group 2 (n = 16) received rocuronium bromide 0.6 mg/kg. Intubation was performed 60 seconds after the administration of muscle relaxant. Patients in Group 1 received atracurium and patients in Group 2 received rocuronium for maintenance if required. MEASUREMENTS: The ease of intubation was scored using a scale of 1 to 4. Onset and offset time monitored with evoked twitch response of the adductor pollicis were recorded. MAIN RESULTS: Intubation was successful in all patients and there was no difference in scores between the two groups. Although onset time was shorter with succinylcholine than with rocuronium, neuromuscular blockade was successfully antagonized in both groups, and the recovery profile was not different between the two groups. CONCLUSIONS: Rocuronium bromide at a dose of 0.6 mg/kg, when used with propofol and fentanyl for induction, provides intubating conditions similar to succinylcholine 1.0 mg/kg at 1 minute. The actual onset time and offset time, however, are significantly longer with rocuronium. There was no difference between atracurium and rocuronium as a maintenance drug. Rocuronium is suitable for surgical procedures greater than 30 minutes, eliminating the need for an additional relaxant to succinylcholine.

Adolescent↗

PubMed1997

Rocuronium versus succinylcholine for rapid-sequence induction using a variation of the timing principle.

STUDY OBJECTIVE: To determine if, using a variation of the "timing" principle, 0.6 mg/kg of rocuronium can achieve an onset time and intubating conditions similar to those achieved with succinylcholine. STUDY DESIGN: Prospective, randomized, double-blind clinical comparison. SETTING: Operating room in a university medical center. PATIENTS: 42 ASA physical status I and II patients undergoing general anesthesia for elective surgery. INTERVENTIONS: All patients were fitted with a Grass FT-10 force transducer attached to the thumb. Supramaximal stimulation was applied to the ulnar nerve with a variable current peripheral nerve stimulator. 22 patients (succinylcholine group) received a placebo bolus injection followed 20 seconds later by thiopental 4 to 5 mg/kg and succinylcholine 1 mg/kg; 20 additional patients (rocuronium group) received a bolus dose of rocuronium 0.6 mg/kg followed 20 seconds later by thiopental 4 to 5 mg/kg and a placebo bolus injection. MEASUREMENTS AND MAIN RESULTS: We measured the onset time from administration of the muscle relaxant to 95% twitch reduction and assessed the quality of intubating conditions 60 seconds after the induction of anesthesia. There was a significant difference in the mean onset time of rocuronium (72 sec) versus succinylcholine (42 sec, p < 0.0001). However, there was no significant difference in intubating conditions 60 seconds after administration of thiopental. CONCLUSION: Rocuronium given 20 seconds prior to thiopental provides intubating conditions equivalent to thiopental-succinylcholine for rapid-sequence inductions, circumventing rocuronium's longer onset time to 95% neuromuscular blockade.

Androstanols↗

PubMed1999

Duration and recovery profile of cisatracurium after succinylcholine during propofol or isoflurane anesthesia.

STUDY OBJECTIVE: To determine the duration and recovery profile of maintenance doses of cisatracurium besylate following succinylcholine, and during propofol or isoflurane anesthesia. DESIGN: Randomized, open-label study. SETTING: Operating suite of a university-affiliated medical center. PATIENTS: Forty ASA physical status I and II adult patients having elective surgery with general anesthesia lasting longer than 90 minutes. INTERVENTIONS: Following a standardized induction sequence, a baseline electromyogram (EMG) was obtained. An intubating dose of intravenous (i.v.) succinylcholine 1.0 mg/kg was administered. Ventilation was maintained with a face mask until the first twitch (T1) of the evoked train-of-four (TOF) reached 10% of control when tracheal intubation was performed. Spontaneous recovery from neuromuscular blockade was allowed to occur until the first twitch returned to 25% of control. Patients then were randomized to receive cisatracurium as follows. Group 1: 0.025 mg/kg [0.5 x 95% effective dose (ED95)]; Group 2: 0.05 mg/kg (ED95); Group 3: 0.05 mg/kg (ED95); and Group 4: 0.1 mg/kg (2 x ED95). Anesthesia for Groups 1 and 2 were maintained with isoflurane 1% to 2%, 66% nitrous oxide (N2O) in oxygen (O2), and in Groups 3 and 4, anesthesia was maintained with propofol 80 to 160 micrograms/kg/min, 66% N2O in O2. The TOF-evoked EMG was recorded at 10-second intervals. The time for the evoked EMG to spontaneously return to 25%, 50%, and 75% of the original baseline was recorded. MEASUREMENTS AND MAIN RESULTS: There were 10 patients in each of the four groups. The duration of action of cisatracurium 0.05 mg/kg (ED95) after an intubating dose of succinylcholine is 24.5 +/- 10 minutes and 21.3 +/- 9 minutes during anesthesia maintained with isoflurance and propofol, respectively. Doubling the dose of cisatracurium resulted in approximately twice the duration of action (40.2 +/- 7 min) during propofol anesthesia. Following a dose of cisatracurium 0.025 mg/kg (0.5 x ED95), the T1 of the EMG-evoked response did not decrease below 25% in 7 of 10 patients. CONCLUSION: Following succinylcholine, the duration of action of a single dose of cisatracurium 0.05 mg/kg is 20 to 25 minutes during anesthesia maintained with propofol or isoflurane. The duration and recovery profile of cisatracurium is dose dependent during propofol and isoflurane anesthetics. Cisatracurium 0.025 mg/kg is an inadequate maintenance dose following recovery from succinylcholine and it fails to provide adequate surgical relaxation.

Adult↗