Abstract
An hypothesis is proposed to account for the occurrence of adverse haemodynamic reactions to succinylcholine. Interaction of succinylcholine with cholinergic receptors is postulated to result in release of endogenous catecholamines (predominantly norepinephrine). The occurrence and the clinical manifestations of the adverse reactions would be dependent on the extent of the release. Based on literature reports of findings in experimental animals with nicotinic and muscarinic agents, a mechanism for the release of norepinephrine is outlined. Interaction of succinylcholine with muscarinic and nicotinic receptors is proposed to result in an initial activation which is followed by a phase of chemical insensitivity. Activation of the presynaptic nicotinic receptors on the poslganglionic sympathetic terminals leads to a short-lasting release of norepinephrine. Activation of the presynaptic muscarinic receptors produces attenuation of the norepinephrine release. In the majority of patients these opposing actions are balanced and the net result is small, variable, and of little clinical importance. An unbalanced response leading to clinical manifestations can be expected if the two types of the presynaptic cholinoceptors are differentially activated.
Résumé
On propose une hypothèse pour expliquer les réactions hémodynamiqu.es indésirables à la succinylcholine: l’interaction de la succinylcholine avec les réeepteurs cholinergiques amènerait le larguage de catécholamines endogènes (surtout la norépinéphrine). Les manifestations cliniques de cette interaction dépendraient de l’importance dtt larguage. En se basant sur des données publiées de l’expérimentation animale avec des agents muscariniques et nicotiniques, onpropose un mécanisme pour ce larguage de norépinéphrine. L’interaction de la succinylcholine avec le récepteur nicotinique ou muscarinique provoque une activation initiate suivie d’une phase d’insensibilté chimique. L’activation des récepteurs pré-synaptiques nicotiniques dans la terminaison sympathique post-ganglionnaire amène une libération brève de norépinéphrine. L’activation des réeepteurs muscariniques pré-synaptiques produít l’effet opposé. Chez la majorité des patients, ces actions opposées sont balancées et h résultat final est de peu d’importance clinique. Une réponse non équilibrée amenant des manifestations cliniques peut survenir si les deux types de cholinocepteurs sont activés différemment.
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An erratum to this article is available at http://dx.doi.org/10.1007/BF03009554.
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Nigrovic, V. Succinylcholine, cholinoceptors and catecholamines: proposed mechanism of early adverse haemodynamic reactions. Can Anaesth Soc J 31, 382–394 (1984). https://doi.org/10.1007/BF03015406
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DOI: https://doi.org/10.1007/BF03015406