Abstract
Succinylcholine is a depolarizing neuromuscular blocking agent, useful as an adjunct to general anaesthesia. Hypersensitivity to succinylcholine might lead to flushing, skin rash, bronchospasm, and shock. However, incidence of bronchospasm is less common in man. A 26 years old female patient at our setup, while undergoing dilatation and evacuation procedure, was administered with Injection Scoline (Succinylcholine) 50 milligrams intravenous. Within a minute, patient was gasping and underwent severe bronchospasms. Her SpO2 was 94% along with development of crepitation with tachypnoea and spasms (>30 respirations/minute). She was immediately resuscitated and intubated by the attending anaesthetist, treated for bronchospasm as well as shifted on ventilator. Within few hours, she was taken off the ventilator and extubated. She was stable then and discharged after two days. Hypersensitivity to NMBAs low incidence of 1 in 6000 - 20,000. NMBAs have a direct effect on mast cells thereby causing hypersensitivity reactions. Succinylcholine is considered to have 1% histamine releasing activity of tubocurarine, producing serious hypersensitivity reactions. This histamine released acts on the effector end-receptors in bronchial wall, leading to bronchoconstriction and sometimes a full-blown spasm. If timely management failed, it can result into an anaesthetic disaster. Rechallenge with succinylcholine was avoided due to possibility of fatal consequences. According to WHO UMC criteria & Naranjo Scale for causality assessment, causality was termed as “Probable”. Keywords: Bronchospasm, Hypersensitivity, Life-threatening, Neuromuscular Blocking Agent (NMBA), Suspected adverse drug reaction.
Highlights
Succinylcholine (Brand Name: Scoline), only depolarizing neuromuscular blocking agent (NMBA) currently used;[1] is administered intravenously (I.V.) and used as an adjunct to general anaesthesia for tracheal intubation and skeletal muscle relaxation during surgery or mechanical ventilation.[2]
We present a case report on succinylcholine, suspected for inducing life-threatening bronchospasm in an obstetric patient while inducing her for general anaesthesia
NMBAs have a direct effect on mast cells thereby causing hypersensitivity reaction
Summary
Succinylcholine (Brand Name: Scoline), only depolarizing neuromuscular blocking agent (NMBA) currently used;[1] is administered intravenously (I.V.) and used as an adjunct to general anaesthesia for tracheal intubation and skeletal muscle relaxation during surgery or mechanical ventilation.[2]. Her pulse rate and blood pressure readings were 116 beats/minute and 146/90millimetre mercury respectively Fifteen minutes later, she was injected with Injection Scoline (Succinylcholine) 50 milligrams I.V. Within a minute of administering Injection Scoline, the patient was gasping and underwent severe bronchospasms. Within a minute of administering Injection Scoline, the patient was gasping and underwent severe bronchospasms Her SpO2 was 94% and vital readings showed pulse rate (120 beats/minute); blood pressure (186/84-millimetre mercury) and crepitation with tachypnoea and spasms (>30 respirations/minute). Indian Journal of Pharmacy and Pharmacology, October-December, 2018;5(4):[211-213] In this case, attending anaesthetist considered acute left ventricular failure as a differential diagnosis for bronchospasm due to pregnancy and precipitated by lithotomy position. Her ECG and two-D ECHO were perfectly normal. Considering shorter duration of action as well; Succinylcholine Hypersensitivity looks like the most appropriate diagnosis
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