Abstract
Succinylcholine is a depolarizing muscle relaxant that has been used for rapid sequence induction and for procedures requiring only a brief duration of muscle relaxation since the late 1950s. The drug, however, has serious side effects and a significant number of contraindications. With the recent introduction of sugammadex in the United States, a drug that can rapidly reverse even large amounts of rocuronium, succinylcholine should no longer be used for endotracheal intubation and its use should be limited to treating acute laryngospasm during episodes of airway obstruction. Given the numerous risks with this drug, and the excellent ablation of airway reflexes with dexmedetomidine, propofol, lidocaine and the larger amounts of rocuronium that can now be administered even for an anesthesia of short duration. The use of succinylcholine for endotracheal intubation should disappear from clinical practice.
Highlights
The depolarizing muscle relaxant drug succinylcholine was introduced in the United Sates in 1952 and has been widely used in clinical medicine since the late 1950s [1,2]
If fade on train of four (TOF) and post-tetanic facilitation are absent or a nondepolarizing block with rocuronium does not reverse with sugammadex, the persistent neuromuscular block is due to succinylcholine and the patient most likely has a pseudocholinesterase deficiency [19]
The complete elimination of the rocuronium-sugammadex complex remains poorly understood in renal impairment and at present its use in patients with severe renal failure is not recommended
Summary
The depolarizing muscle relaxant drug succinylcholine was introduced in the United Sates in 1952 and has been widely used in clinical medicine since the late 1950s [1,2]. Unlike the cardiac arrests that occur with myopathies and immobilization, the prolonged neuromuscular block in patients with pseudocholinesterase deficiency is not fatal as long as the persistent weakness is recognized and appropriately treated prior to extubation.
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