In patients with head injuries who undergo rapid sequence intubation using succinylcholine, does pretreatment with a competitive neuromuscular blocking agent improve outcome? A literature review.
A literature search was undertaken for evidence of the effect of succinylcholine (SCH) on the intracranial pressure (ICP) of patients with acute brain injury and whether pretreatment with a defasciculating dose of competitive neuromuscular blocker is beneficial in this patient group. The authors could find no definitive evidence that SCH caused a rise in ICP in patients with brain injury. However, these studies were often weak and small. For those patients suffering acute traumatic brain injury the authors could find no studies that investigated the issue of pretreatment with defasciculating doses of competitive neuromuscular blockers and their effect on ICP in patients given SCH. There is level 2 evidence that SCH caused an increase in ICP for patients undergoing neurosurgery for brain tumours with elective anaesthesia and that pretreatment with defasciculating doses of neuromuscular blockers reduced such increases. It is unknown if this affects neurological outcome for this patient group.
Clancy
M
M
Emergency Department, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. clancm@hotmail.com
Halford
S
S
Walls
R
R
Murphy
M
M
D002560:Cerebrovascular Circulation / Q000187:drug effects; D006259:Craniocerebral Trauma / Q000134:cerebrospinal fluid / Q000503:physiopathology*; D004569:Electroencephalography / Q000187:drug effects; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects*; D007442:Intubation, Intratracheal; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage*; D011229:Preanesthetic Medication; D013390:Succinylcholine / Q000008:administration & dosage*; D016896:Treatment Outcome
D009466:Neuromuscular Blocking Agents; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine