[Succinylcholine--update].
The action profile of succinylcholine is unmatched even 50 years after its introduction into anaesthestic practice. This is probably why succinylcholine, despite its many and partly life-threatening side-effects, is still considered to be indispensable by many anaesthetists and emergency doctors. The main indication for succinylcholine--the facilitation of endotracheal intubation in patients considered to be at an increased risk of aspiration of gastric fluid, e.g. patients undergoing a Caesarean section or presenting with an ileus--remains undisputed. Some of the side-effects of succinylcholine can be diminished by precurarisation. However, just like priming, this technique holds some considerable dangers (such as a clinically significant attenuation of the protective reflexes) and has become a matter of increasing controversy. Rocuronium (> or = 1 mg/kg) is currently the best alternative to succinylcholine for rapid sequence induction. The routine use of succinylcholine as a relaxant for intubation is questionable, mainly because there are a number of modern anaesthetic techniques (laryngeal mask airway) and new drugs (rocuronium, mivacurium, remifentanil) which make succinylcholine quite dispensable except for a few situations (e.g. re-positioning of fractures). In the case of an expected difficult airway no muscle relaxant should be given, because severe hypoxaemia in these patients probably can only be prevented by a professional airway management. Succinylcholine is no longer an option in elective paediatric anaesthesia. The drug, however, retains its value in critical situations where a rapid onset but a short duration of action is of prime importance.
Sparr
H J
HJ
Universitätsklinik für Anaesthesie und Allgemeine Intensivmedizin, Anichstrasse 35, 6020 Innsbruck, Osterreich. harald.j.sparr@uibk.ac.at
Jöhr
M
M
D000818:Animals; D002648:Child; D006801:Humans; D009467:Neuromuscular Depolarizing Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology; D009469:Neuromuscular Junction / Q000187:drug effects; D013390:Succinylcholine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology
D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine