Abstract
Pretreatment with small (10 mg) doses of succinylcholine (“self-taming”) decreases the incidence of muscle fasciculations following succinylcholine administration and may decrease the incidence of other unwanted effects. This study was designed to assess the cardiac effects of such self-taming and to assess the degree of protection afforded against bradydysrhythmias following subsequent succinylcholine administration. Sixty patients were studied and allocated randomly to three groups of twenty. Each group was assigned a different form of pretreatment. Patients in group I received 10 mg of succinylcholine immediately after induction. Patients, in group II were treated with d-tubocurarine 0.04 mg • kg-1 three minutes before induction. Patients in group III received no pretreatment. All patients were induced with thiopentone 4 mg • kg-1 followed by succinylcholine 1 mg • kg-1 45 seconds later. A second dose of succinylcholine 1 mg • kg-1 was administered to the patients in the two pretreatment groups between four and five minutes after the first dose of succinylcholine. Following both the first and second doses of succinylcholine patients in the self-taming group showed a significantly greater incidence of bradydysrhythmias when compared to the other two groups. It is concluded that the use of a self-taming technique is potentially hazardous, and that it does not confer protection against repeated succinylcholine administration.
Résumé
L’Administration d’une petite dose (10 mg) de succinylcholine précédant la dose dépolarisante de cet agent diminue 1’incidence des fasciculations musculaires couramment observéers avec le succinylcholine et pourrait également diminuer l’incidence d’autres effets indésirables. L’objet de ce travail était de vérifier si l’administration préalable d’une petite dose de succinylcholine diminuait aussi l’incidence des bradyarythmies fréquemment associées à 1’usage de ce dépolarisant.
Soixante patients ont été étudiés. Us ont été assignés au hasard à l’une de trois groupes. Ceux du groupe I ont reç,u 10 mg de succinylcholine immédiatement après l’induction de I’anesthésie, ceux du groupe II, 0.04 mgkg-1 de d-tubocurarine trois minutes avant l’induction, alors que les patients du groupe III n’ont reçu aucun pré-traitement. L’induction de l’anesthésie de tous les patients a été effectuée au thiopental 4 mgkg-1 suivi, après intervalle de 45 secondes, d’une dose de succinylcholine 1 mg • kg-1. Une dose semblable de succinylcholine etait répétée chez les patients des deux premiers groupes, quatre a cinq minutes apràis la première dose de cet agent. Les patients ayant reçu la petite dose (10 mg) de succinylcholine avant la dose dépolarisante (premier groupe) ont présenté une incidence significativement plus é1evée de bradyarythmies que ceux des deux derniers groupes.
Nous concluons que l’administration d’une petite dose de succinylcholine avant la dose dépolorisante peut être dangeureuse, et ne protège pas contre les arythmies associées avec les doses subséquentes de cet agent.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Stoelting, R.K. &Peterson, Adverse effects of increased succinylcholine dose following d-tubocurarine pretreatment. Anesth. Analg. (Cleve).54: 282 (1975).
Paula, A.L., Reynolds, R.C. &Strobel, G.E. Inhibition of suxamethonium relaxation by tubocurarine and gallamine pretreatment during induction of anaesthesia in man. Br. J. Anaesth.47: 1067 (1975).
Baraka, A. Self-taming of succinylcholine-induced fasciculations. Anesthesiology.46: 292 (1977).
List, W.F.M. Succinylcholine-induced cardiac arrhythmias. Anesth. Analg. (Cleve). 50: 361 (1971).
Viby-Mogensen, J., Wisborg, K. &Soren-Sen, O. Cardiac effects of atropine and gallamine in patients receiving suxamethonium. Br. J. Anaesth.52: 1137(1980).
Brodsky, J.B. &Brock-utne, J.G. Does “self-taming“ with succinylcholine prevent postoperative myalgia? Anesthesiology.50: 265 (1979).
Verma, R.S. “Self-taming“ of succinylcholine- induced fasciculations and intraocular pressure. Anesthesiology.50: 245 (1979).
Meyers, E.F., Singer, P. &Otto, A. A controlled study of the effect of succinylcholine self-taming on intraocular pressure. Anesthesiology.53: 72 (1980).
Charak, D.S. &Dhar, C.L. Suxamethonium induced changes in serum creatine phosphokinase. Br. J. Anaesth.53: 955 (1981).
Leigh, M.D., McCoy, D.D., Belton, M.K. &Lewis, J.B. Bradycardia following intravenous administration of succinylcholine to infants and children. Anesthesiology.18: 698 (1957).
Schoenstadt, D.A. &Whitcher, C.E. Observations on the mechanism of succinylcholine- induced cardiac arrhythmias. Anesthesiology.24: 358 (1963).
Andersen, J.R. &EIKard, Arrhythmias during halothane anaesthesia III. The influence of the barbiturates. ACTA Anaesthesiol. Scand.22: 430 (1978).
Karhunen, U., Heinonen, J. &Tammisto, T. The effect of tubocurarine and alcuronium on suxamethonium induced changes in cardiac rate and rhythm. ACTA Anaesthesiol. Scand.16: 3 (1972).
Taylor, D. The mechanism of action of muscle relaxants and their antagonists. Anesthesiology.20: 439 (1959).
Silar, J.N., Cook, F.J. &Ricca, J. Does “Self-Taming” Decrease Post-operative Myalgia in Outpatients? Anesthesiology.52: 98 (1980).
Viby-Mogensen, J., WlSBORG, K., GaBRIELsen, J. &Spotoft, H. Halothane anaesthesia and suxamethonium I: The significance of pre- operative atropine administration. ACTA Anaesthesiol. Scand.20: 129 (1976).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Magee, D.A., Sweet, P.T. & Holland, A.J.C. Cardiac effects of self-taming of succinylcholine and repeated succinylcholine administration. Canad. Anaesth. Soc. J. 29, 577–580 (1982). https://doi.org/10.1007/BF03007744
Issue Date:
DOI: https://doi.org/10.1007/BF03007744