Case: A relatively innocuous case concerning the transportation of a Parkinson’s disease¹ sufferer lead onto that age-old discussion about our old friend the depolarising neuromuscular blocker² and which weird and wonderful neurological or neuomuscular problems it could or should not be used for.

Challenge: To use sux or not to use sux, that is the question.

Learning points: The figure below highlights those conditions where careful consideration of the use of Sux is indicated^3 4. Your next line of defence is Rocuronium. Given in sufficient doses, Roc has as quick an onset time as Sux in a practical setting⁵.

Wanky disclaimer: Suxamethonuim causes some increase in K⁺ in ALL that are given it. Therefore any condition that might result in an increased K⁺ can have a further surge in K⁺once given the drug³.

Reference: 

1. Parkinson’s Disease and Anaesthesia
Indian J Anaesth. 2011 May-Jun; 55(3): 228–234 Free full text

2. Suxamethonium article from frca.co.uk

3. Suxamethonium article from Update in Anaesthesia

4. Information for Health Professionals: Suxamethonium Chloride Injection B.P.

5. Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases.
Anesth Analg 2005; 101:1356–61 Free full text

“Quod medicina aliis, aliis est acre venenum”