Incidence Of Fasciculations Research Articles

Comparative Evaluation of Effectiveness of Rocuronium Bromide vs. Succinyl Choline on Quality of Intubating Conditions during General Anesthesia

Objectives: To compare the quality of intubating conditions and hemodynamic responses to the administration of Rocuronium Bromide and Succinyl Choline during general anesthesia.Methods: This was a comparative study conducted at the anesthesiology department of a tertiary care medical college. Sixty patients undergoing various surgeries under general anesthesia were included in this study based on predefined inclusion and exclusion criteria. Patients were divided into Group S (receiving succinylcholine) and Group R (receiving rocuronium). In all patients, the quality of intubating conditions was assessed. Excellent or good conditions were considered to be acceptable intubating conditions, whereas fair and poor conditions were considered unacceptable.Results: Mean age, weight, gender distribution, and ASA grades were comparable in both groups. The overall quality of intubation was found to be better in group S than in group R, and the difference was statistically significant (P=0.004). The duration of action was significantly longer in group R than in group S (P<0.001). Hemodynamic stability was comparable in both the groups, except for heart rate at 10 min, which was higher in Group R than in Group S. Incidence of fasciculation was significantly more in Group S as compared to Group R, and the difference was found to be highly significant (P=0.0001).Conclusion: Succinylcholine for rapid sequence intubation is associated with better intubation conditions than rocuronium.

The Effects of Prophylactic Intravenous Lignocaine vs Vecuronium on Succinylcholine-Induced Fasciculation and Postoperative Myalgia in Patients Undergoing Elective Surgery at Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2022: Prospective Cohort Study.

The incidence and severity of succinylcholine-induced fasciculation and postoperative myalgia have been shown to decrease when vecuronium bromide or preservative-free 2% plain lignocaine hydrochloride is administered before induction. The aim of this study is to examine the effectiveness of defasciculation dosages of vecuronium bromide and 2% preservative-free plain lignocaine hydrochloride in decreasing succinylcholine-induced fasciculation and postoperative myalgia in patients undergoing elective surgery. A total of 110 participants were included in a prospective observational cohort study that was located in an institution. Patients were randomly assigned to (Group L) and (Group V) based on the prophylactic measures they received from the responsible anesthetist utilizing preservative-free 2% plain lignocaine and defasciculation dose of vecuronium bromide, respectively. We recorded, socio-demographic variables, fasciculation, postoperative myalgia, total number of analgesics administered following surgery in 48hrs, and kind of procedure. The descriptive data were compiled using descriptive statistics. Categorical and continuous data were evaluated, respectively, using chi-square statistics and the independent sample t-test. To compare the prevalence of fasciculation and myalgia across the various groups, the Fischer exact test was performed. A 0.05 p-value was deemed statistically significant. This study found that the incidence of fasciculation in the groups receiving the defasciculation doses of vecuronium bromide and preservative-free 2% plain lignocaine hydrochloride was 14.6% and 20% (p-value 0.007), respectively. The rate of mild-to-moderate postoperative myalgia in the vecuronium bromide group was 23.7%, 30.9%, and 16.4% in the first, 24th, and 48th hours, respectively (p-value 0.001), as opposed to 0%, 37.3%, and 9.1%, respectively (p-value 0.008) in the group receiving preservative-free 2% plain lignocaine hydrochloride. Pretreatment with 2% plain lignocaine that is preservative-free is more efficient than vecuronium bromide at reducing the frequency and intensity of postoperative succinylcholine-induced myalgia, whereas defasciculation dose of vecuronium was more effective prevention of succinylcholine-induced fasciculation.

Efficacy of Magnesium Sulphate in Attenuation of Succinylcholine Induced FasciculationsA Randomised Clinical Study

Introduction: Magnesium Sulphate (MgSO4 ) pre-administration is effective in reducing Succinylcholine (Sch) induced fasciculations due to its effect at presynaptic end plate. Magnesium competes with calcium at the pre-synaptic end plate of neuromuscular junction and inhibits the release of acetylcholine (Ach) from the motor nerve terminal and to a lesser extent, decreases the sensitivity of the postjunctional membrane and reduces the excitability of the muscle fibre. Aim: To evaluate three doses of MgSO4 in reducing the incidence and severity of fasciculations and correlate with the serum magnesium levels. Materials and Methods: This prospective, randomised clinical trial was at Vijayanagar Institute of Medical Sciences (VIMS), Ballari, India. Ninety consenting adult patients aged 20-50 years scheduled for elective surgeries with endotracheal intubation under general anaesthesia were randomly allocated to three groups- Group 1, Group 2 and Group 3, to receive Injection (Inj.) MgSO4 20 mg/kg, 30 mg/kg and 40 mg/kg, respectively, before induction. Induction with Inj. propofol (2 mg/kg) was followed by administration of Inj. Sch (1.5 mg/kg). The main outcome parameters were the incidence of fasciculations and grading of the severity. Haemodynamic responses from the basal levels and after intubation, and adverse effects to the study drugs were noted. Chi-square test was used to find the significance of study parameters on categorical scale among the groups. Probability values at <0.05 were considered as significant. Results: The incidence of fasciculations was 90%, 53.4% and 43.4% in groups 1, 2 & 3, respectively. Greater number of patients had grade 3 fasciculations in group 1 (20%), compared to group 2 and group 3 (3.4% and nil) respectively. The fall in blood pressure after MgSO4 was comparable among the three groups. Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) increased by 23.5% and 18.5%, 7.9% and 4.1% and 2.8% and 2.7% in groups 1, 2 and 3, respectively at one minute. The SBP and DBP at 3rd and 5th minute stayed at statistically significant greater levels in group 1 as compared to groups 2 and 3, but were similar in groups 2 and 3 overall. The Heart Rate (HR) changes followed similar trend in all 3 groups. Incidence of feeling of warmth was highest in group three as compared to other groups. Conclusion: MgSO4 at 40 mg/kg can be the optimal dose to suppress Sch-induced fasciculations, with better attenuation of intubation associated haemodynamic changes.

Effect of oral low dose pregabalin on succinylcholine induced fasciculations and myalgia -A prospective randomized double blind placebo-controlled study

Introduction: Among the depolarizing muscle relaxants, Succinylcholine is the widely used depolarizing agent until today in anaesthesia practice. Side effects like hyperkalemia, fasciculations, myalgia, increased intracranial pressure and intraocular pressure are common with the use of this drug. Pretreatment with various drugs have been proven to lessen these side effects. In our study, low dose of oral pregabalin was used as a premedication to assess its effects on the incidence and severity of fasciculations and postoperative myalgia caused by Succinylcholine administration. Materials and Methods: 60 patients of either gender undergoing elective ENT surgeries under general anaesthesia were randomly allocated to two groups of 30 each. Patients in Group PG (pregabalin group) received 75 mg of pregabalin orally 1 h prior to surgery and patients in Group CG (control group) received matching placebo. Fasciculations and myalgia grading was done by a blinded observer. Haemodynamic variables were measured at regular intervals. Results: Both groups were comparable in regard to Demographic data (p > 0.05). We didn’t find any significant difference in the fasciculations incidence (p=0.702) and myalgia incidence (p=0.081) between the two groups. But the severity of fasciculations is statistically significant between the groups (< 0>P < 0> Conclusion: Low dose oral pregabalin- 75 mg decreases the severity of succinylcholine-induced fasciculations and myalgia. There is not much effect on the incidence of fasciculations and myalgia in patients undergoing elective ENT surgeries. Keywords: Succinylcholine, Low dose Pregabalin, Fasciculations, Myalgia.

Usefulness of propofol to prevent succinylcholine induced fasciculations and myalgia, a comparison with thiopentone sodium as an induction agent

Background: Succinylcholine induced fasciculations and myalgia may be a source of greater distress to the patient than the surgical pain. Aims & Objective: This study was designed to see if propofol offered any protection against succinylcholine induced fasciculations and myalgia compared with thiopentone sodium. Material and Methods: This prospective, randomized study was conducted in a teaching and tertiary care hospital. The study included 99 adult patients scheduled to undergo general anaesthesia for elective surgery. The patients were allocated randomly and equally into Group P1, P2 and T. Anaesthesia was induced in group P1 with propofol 2.5 mg/kg, group P2 with propofol 3.5 mg/kg and group T with thiopentone sodium 5 mg/kg. Tracheal intubation was facilitated by administration of intravenous succinylcholine 2 mg/kg. Incidence and severity of fasciculations were recorded. Anaesthesia was maintained with 50% Nitrous oxide in oxygen, Isoflurane and Vecuronium bromide. At the end of surgery, neuromuscular blockage is reversed and patients were extubated. All the patients were assessed at 6, 12 and 24 hours postoperatively to evaluate the incidence and severity of myalgia. Anova test was applied for quantitative data and Chi-square test for qualitative data. P value < 0.05 was taken as significant. Results: The demographic data of patients of the three groups were comparable. The total incidence of fasciculations were 25(75.76%), 16(48.48%) and 26(78.79%) in group P1, P2 and T respectively (p

Prophylactic use of gabapentin for prevention of succinylcholine-induced fasciculation and myalgia

Succinylcholine is used for rapid-sequence induction of anesthesia. Fasciculations and myalgia are adverse effects. The pretreatment modalities prevent or minimize its adverse effects. The present study is designed to evaluate the efficacy of gabapentin on the incidence of fasciculation and succinylcholine-induced myalgia. The study was conducted at a tertiary care teaching hospital in a randomized, double-blinded, placebo-controlled manner. Patients of both genders undergoing laparoscopic cholecystectomy were randomly assigned to two groups. Patients in Group I (Gabapentin group) received 600 mg of gabapentin orally 2 h prior to surgery and patients in Group II (placebo group) received matching placebo. Anesthesia was induced with fentanyl 3 μg/kg, thiopentone 3-5 mg/kg and succinylcholine 1.5 mg/kg. All patients were observed and graded for fasciculations by a blinded observer and patients were intubated. Anesthesia was maintained with oxygen in air, sevoflurane and intermittent vecuronium bromide. After completion of surgery, neuromuscular blockade was reversed. A blinded observer recorded myalgia grade at 24 h. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. Demographic data, fasciculation grade, fentanyl consumption, and myalgia grade were compared using student t test and test of proportions. The study included 76 American Society of Anesthesiologists' Grade I or II patients of either gender undergoing laparoscopic cholecystectomy. But only 70 patients completed the study. Results demonstrated that the prophylactic use of gabapentin significantly decreases the incidence and the severity of myalgia (20/35 vs. 11/35) (P<0.05) and decreases fentanyl consumption significantly in the study group (620+164 μg vs. 989+238 μg) (P<0.05) without any effects on the incidence and severity of fasciculations. Prophylactic use of gabapentin 600 mg in laparoscopic cholecystectomy decreases the incidence and severity of myalgia and fentanyl consumption.

Fasciculations after rattlesnake envenomations: A retrospective statewide poison control system study

Introduction. Rattlesnake envenomation occasionally results in repetitive small-muscle fasciculations known as myokymia. We report the results of a retrospective inquiry of this phenomenon from a statewide poison center's database. Methods. Data was obtained from a poison system database for the years 2000–2003, inclusive, for rattlesnake envenomation exposures coded as having fasciculations. Results. A total of 47 cases were identified, and nine other cases were found from previously published literature. There was no consistent temporal pattern by monthly analyses in incidence or proportion of reported snakebites with myokymia. All four of the reviewed cases with myokymia of the shoulders were intubated and none without it were intubated. Conclusions. A review of four consecutive years of data revealed no pattern to correlate the incidence of fasciculations with the month. The development of respiratory failure associated with myokymia, sometimes despite antivenom, is a newly reported occurrence. Clinicians are reminded to monitor closely airway and inspiratory capacity in patients with severe myokymia.

Prevention of Succinylcholine-induced Fasciculation and Myalgia

Fifty-two randomized trials (5,318 patients) were included in this meta-analysis. In controls, the incidence of fasciculation was 95%, and the incidence of myalgia at 24 h was 50%. Nondepolarizing muscle relaxants, lidocaine, or magnesium prevented fasciculation (number needed to treat, 1.2-2.5). Best prevention of myalgia was with nonsteroidal antiinflammatory drugs (number needed to treat, 2.5) and with rocuronium or lidocaine (number needed to treat, 3). There was a dose-dependent risk of blurred vision, diplopia, voice disorders, and difficulty in breathing and swallowing (number needed to harm, < 3.5) with muscle relaxants. There was evidence of less myalgia with 1.5 mg/kg succinylcholine (compared with 1 mg/kg). Opioids had no impact. Succinylcholine-induced fasciculation may best be prevented with muscle relaxants, lidocaine, or magnesium. Myalgia may best be prevented with muscle relaxants, lidocaine, or nonsteroidal antiinflammatory drugs. The risk of potentially serious adverse events with muscle relaxants is not negligible. Data that allow for a risk-benefit assessment are lacking for other drugs.

Attenuation of suxamethonium myalgias. Effect of midazolam and vecuronium

We studied the incidence of fasciculations and postoperative myalgias in 100 female outpatients who had laparoscopy under thiopentone, N2O, isoflurane anaesthesia. Four groups of 20 patients each were pretreated with saline (group 1), tubocurarine 0.05 mg/kg (group 2), vecuronium 0.006 mg/kg (group 3), or midazolam 0.025 mg/kg (group 4), followed by suxamethonium 1.5 mg/kg. Group 5 received only vecuronium 0.1 mg/kg as relaxant (no suxamethonium). Fasciculations were graded, and postoperative myalgias rated on the first and third postoperative days. In groups 1-5 the incidence of fasciculations was 95, 15, 25, 95 and 0%; the incidence of myalgias on the first day after operation was 70, 45, 65, 75 and 60%, and on the third day after operation 20, 5, 20, 20, and 5%, respectively. We conclude that pretreatment with vecuronium, but not midazolam, decreases the incidence of fasciculations after suxamethonium (p less than 0.05) and that in this patient population, postoperative myalgias appear to be unrelated to the use of suxamethonium.

Diazepam and suxamethonium muscle pain (a dose-response study).

Postoperative muscle pain occurred in 17.2% of patients given diazepam intravenously 5 minutes prior to suxamethonium. The incidence of muscle pain was 48% in those patients who were not given diazepam before suxamethonium. The difference is statistically significant (p less than 0.01). Five mg diazepam reduced the incidence of pain but not significantly (p = 0.30); 10 mg diazepam significantly reduced the incidence (p less than 0.05); while 15 and 20 mg diazepam showed better effects (p less than 0.01). Diazepam pretreatment also reduced the severity, frequency and duration of muscle pain. The incidence of fasciculations was significantly reduced but there was no correlation between the incidence of fasciculations and the occurrence of muscle pains.