Potassium Response to Succinylcholine

Abstract

To the Editor:— I read with great interest the article by Birch et al and the companion editorial on hyperkalemia induced by succinylcholine chloride in patients with trauma ( 210: 490; 549, 1969). I am impressed by the thoroughness with which they investigated the mechanisms of potassium release. However, I feel that they have overstated the implications regarding curare as a blocker of this response. In their studies, they administered 6 mg of curare five minutes prior to a second dose of succinylcholine and blocked the abnormal elevations of serum potassium that had been seen with an initial dose of succinylcholine. From this they concluded that pretreatment with curare eliminated the risk of hyperkalemia associated with succinylcholine in patients with trauma. Data from a single patient with burns, treated at the US Army Institute of Surgical Research, Brooke General Hospital, San Antonio, Tex, contradict this conclusion. The responses of this patient were