Suxamethonium and neurological disorders
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 indicated3 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.
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”
Cliff; what about old CVAs with residual hemiparesis? This is an area of concern, without great evidence.
Thanks Scott for highlighting this – you’ve inspired me to write a blog post dedicated to sux and CVAs – kind regards, Laurence.
I’ll leave Dr Laurence Boss, the author of the post, to give his take on it
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