Abstract
BackgroundSugammadex allows rapid recovery from rocuronium-induced neuromuscular blockade. Succinylcholine is often used for brief surgeries but is associated with myalgia, headache, histamine release, and increased lactate levels. Thus, we hypothesized that succinylcholine may affect emergence agitation (EA) and compared the effects of succinylcholine and rocuronium-sugammadex on EA in patients undergoing closed reduction of a nasal bone fracture under general anesthesia.MethodsForty-two patients were prospectively enrolled and allocated randomly to the succinylcholine group (group SC) or the rocuronium-sugammadex group (group RS; each n = 21). Neuromuscular block and its reversal were achieved with succinylcholine and normal saline in group SC, whereas rocuronium and sugammadex were administered in group RS. After surgery, the incidence of EA as a primary outcome, the incidence of dangerous EA, and duration of EA as secondary outcomes were compared.ResultsThe incidence of EA was higher in group SC than in group RS (90.5% vs. 47.6%, respectively; relative risk [RR] 4.3; 95% confidence interval [CI] 1.2 to 15.7; P = .006). The incidence of dangerous EA increased in group SC compared to group RS (33.3% vs. 4.8%, respectively; RR 2.1; 95% CI 1.3 to 3.4; P = .045). The duration of agitation was longer in group SC than in group RS [106.5 (65.1) vs. 40.4 (26.0) sec; mean difference 66.1 s; 95% CI 31.0 to 101.1; effect size 1.3; P = .001).ConclusionSuccinylcholine increases the incidence, severity, and duration of EA compared to rocuronium-sugammadex in patients undergoing closed reduction of a nasal bone fracture.Trial registrationCRiS Registration number KCT0002673. Initial registration date was 31 January 2018 (Retrospectively registered).
Highlights
IntroductionSuccinylcholine is often used for brief surgeries but is associated with myalgia, headache, histamine release, and increased lactate levels
Sugammadex allows rapid recovery from rocuronium-induced neuromuscular blockade
In total, 46 patients were assessed for eligibility (28 November 2017 to 17 April 2018), and 4 were excluded; 3 patients had another fracture in addition to the nasal bone fracture and 1 patient refused to participate in the study
Summary
Succinylcholine is often used for brief surgeries but is associated with myalgia, headache, histamine release, and increased lactate levels. We hypothesized that succinylcholine may affect emergence agitation (EA) and compared the effects of succinylcholine and rocuronium-sugammadex on EA in patients undergoing closed reduction of a nasal bone fracture under general anesthesia. Succinylcholine is a depolarizing neuromuscular blocking agent with a rapid onset time and a short duration of action; it has been used for rapid sequence induction or short-duration procedures, such as closed reduction of a nasal bone fracture, despite its numerous side effects [2,3,4,5]. A case report suggested that rocuronium-sugammadex reduces the severity of agitation following electroconvulsive therapy by decreasing the increase in plasma lactate level compared to succinylcholine [8]. Succinylcholine can result in myalgia, headache, histamine release, increased intraocular pressure, and activation of the electroencephalogram [5, 9]
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