Postoperative Myalgia Research Articles

Prevention of Succinylcholine Induced Postoperative Myalgia by Pretreatment with Lignocaine: A Randomized Controlled Study

Succinylcholine, a depolarizing muscle relaxant possesses a unique property of rapid onset and short duration of action, but is accompanied by side effects such as fasciculation and myalgia. The aim of this study was to investigate the prophylactic effect of intravenous lignocaine on the incidence and severity of succinylcholine-induced postoperative myalgia. This was a randomized controlled double blind study conducted at National Institute of ENT Dhaka, during September to December 2017. Eighty adult patients of American Society of Anesthesiologists status I and II of both sexes for elective surgery under general anesthesia were randomly allocated into two equal groups, lignocaine group and normal saline group. The patients of lignocaine group were pretreated with lignocaine 1.5 mg/kg body weight in 5 ml volume, while patients of normal saline group were given isotonic saline 0.9% in the same volume (5 ml) intravenously. Thereafter, anesthesia was induced in all patients, by injecting 1.5 mg/kg of fentanyl and 2 mg/kg of propofol intravenously. Following the loss of eyelid reflex, 1.5 mg/kg of succinylcholine was injected intravenously as a muscle relaxant and then the patients were intubated. The incidence and severity of myalgia were assessed by a blinded observer 24 hours after surgery. In terms of demographic data, the results of this study showed that there is no significant difference between patients in both groups (P>0.05). Overall, the incidence and severity of succinylcholine-induced myalgia in lignocaine group was significantly less, when compared with normal saline group (P<0.05). Pretreatment with intravenous lignocaine is effective in prevention of postoperative succinylcholine induced myalgia. Faridpur Med. Coll. J. Jan 2019;14(1): 13-15

Magnitude and Associated Factors of Postoperative Myalgia Among Patients Who Undergo Surgery in Wolaita Sodo Teaching and Referral Hospital, Southern Ethiopia

Introduction: Even though, Suxamethonium is the only short acting and accepted standard for rapid sequence intubation, it is associated with a high risk of complications. Some complications are minor, but others are potentially life threatening. Post-operative myalgia and fasciculation are the two most common and distressing side effects of succinylcholine administration. Objective: To assess the magnitude and associated factors of postoperative myalgia following Suxamethonium administration among patients undergoing surgery in Wolaita Sodo Teaching and Referral Hospital from April 30- May 30, 2019. Methods: Facility based cross sectional survey will be conducted by using convenient sampling technique. Training was given for data collectors and supervisors. Regular supervision and follow up were made. Data was entered in to Epi info version 7 software and transported to SPSS version 20 for analysis. Odd ratio and 95% confidence interval was computed. Bivariate and Multivariate analysis used to identify factors associated with hypotension. Results: The magnitude of postoperative myalgia is high at 12 hour in which 18 (36%) develop mild pain where us the magnitude is lower at 24 hour, 14 (28%). More than half 27 (54%) have no postoperative myalgia at 12 hour. Patients who did not take pretreatment agent before administration of Suxamethonium were 15 times more likely to develop post-operative myalgia at 12 hour when compared to patients who take pretreatment agent before Suxamethonium administration (AOR=15.12, 95%CI: 1.39, 163.53) Conclusion: The magnitude of Suxamethonium induced myalgia is higher at 12 hour than 24 hour post operative and lack of per-treatment agent and repeated dose of Suxamethonium are main risk factors of postoperative myalgia.

To compare the efficacy of oral aspirin vs intravenous diazepam on succinylcholine induced postoperative myalgia

Introduction: Succinylcholine is a short acting neuromuscular blocking age nt.. It has its own side effects which includes dysrhythmias, hyperkalemia, postoperative myalgias, etc. The incidence of muscle pain ranges from 0.2 to 89% and thus the need for the study. Materials and Methods: 60 adult patients are included in this prospective , randomised , double blind study who are scheduled to undergo elective surgery under general anaesthesia. Two groups were made randomly and Patients received either oral aspirin 600mg one hour before surgery or intravenous diazepam fifteen minutes before induction. Appropriate statistical tests were applied. Results: Status of muscle pain was recorded at 1st , 6th, 12th and 24th post operative period. Myalgia at 6th, 12th and 24th hour was significantly reduced in aspirin group compared to diazepam group. No difference was seen at one hour. Conclusion: It was concluded that aspirin prevents succinylcholine induced myalgia more effectively than diazepam in postoperative period. Keywords: Aspirin, Diazepam, Myalgia, Succinyl choline.

Role of Magnesium Sulphate in Attenuating Succinylcholine Induced Fasiculations and Post-Operative Myalgia

Role of Magnesium Sulphate in Attenuating Succinylcholine Induced Fasiculations and Post-Operative Myalgia

Evaluation of Prophylactic Effect of Intramuscular Diclofenac Sodium for Prevention of Succinylcholine-Induced Myalgia

Background: Succinylcholine a depolarizing muscle relaxant with rapid onset, predictable course and short duration of action is associated with myalgia.
 Objectives: To assess the efficacy of intramuscular injection of diclofenac sodium in preventing succinylcholine-induced myalgia.
 Materials and Methods: Eighty healthy adults scheduled for elective surgery under general anesthesia were enrolledin a double-blind study and randomly allocated into two groups of forty patients. Patients in Group I (diclofenacgroup) were pretreated with inj. diclofenac 75 mg deep intramuscularly into gluteal region one hour prior to induction of anesthesia, while patients in Group II (saline group) received an equivalent volume of saline inj. in same site. Anesthesia was induced in both groups with fentanyl 1.5 mcg/kg, propofol 2.0 mg/kg and succinylcholine1.5 mg/kg. Postoperative myalgia was assessed 24 hours after induction and graded as nil, mild, moderate, or severe.
 Results:The demographic data for both groups were comparable (p > 0.05). Postoperative myalgia was recorded at 24 hours after induction in diclofenac group with twelve (30%) patients and 24 (60%) patients in normal saline (control) group respectively (p < 0.05). Conclusion: Prophylactic use of intramuscular injection of diclofenac is effective in the prevention of postoperative myalgia
 KYAMC Journal Vol. 10, No.-1, April 2019, Page 35-38

PROPOFOL-FENTANYL FOR TRACHEAL INTUBATION IN CHILDREN WITHOUT NEUROMUSCULAR BLOCK

INTRODUCTION: In paediatric anaesthesia tracheal intubation without prior administration of muscle relaxants is well-established practice. Depolarizing muscle relaxant such as suxamethonium is also used in induction but it may be associated with side effects such as postoperative myalgia, prolonged paralysis, and increase in intraocular pressure and hyperkalaemia.
 MATERIAL AND METHODS:A total of 60 children were included in the study, of both sex, aged between 2 and 12 years. Patients were randomised in to two groups: Group 1: Inj. Fentanyland Inj. Propofoland group 2 : Inj. Propofol and Inj. suxamethonium.The quality of intubation was graded by the consultant using the scoring system devised by Helbo-Hansen Raulo and Trap-Anderson.
 RESULTS: A total of 60 patients were included in the study and were randomised in to two groups of 30 each.In group 1 mean age was 8.24±2.65 and in group 2 it was 7.96±2.77. Weight in group 1 was 21.58±6.22 and in group 2 was 22.87±5.59. There were 18 male and 12 female in group 1, while in group 2 there were 19 male and 11 female. No statistically significance e=was observedin both the group.Acceptable intubating conditions were observed in 29 (97%) out of 30 patients in group 1, whereas all (100%) patients in group S had excellent intubating conditions.
 CONCLUSION: Tracheal intubation can be accomplished using a combination of Fentanyl Propofol combination and suxamethonium (muscle relaxant) can be avoided. When neuromuscular blocking drugs are contraindicated this method can be used.

The use of minidose muscle relaxant to facilitate insertion of a laryngeal mask airway

Background Laryngeal mask airway (LMA) has gained wide acceptance for airway management especially in day case surgery. Although propofol is known to blunt laryngeal reflexes, smooth and successful insertion of LMA requires a proper mouth opening to minimize airway reflexes such as gagging, coughing, and laryngospasm. The concurrent use of mini‐dose muscle relaxant with propofol could reduce the occurrence of airway reflexes and increase the success rate of LMA insertion. Aim of the study The aim of this study is to evaluate the effect of minidose atracurium and succinylcholine, to facilitate LMA insertion and which is better of them to achieve more satisfaction and less complications following induction of anesthesia with propofol, in day case surgery patients. Patients and methods This prospective, randomized, controlled, double-blind study was done on 90 healthy patients with American Society of Anesthesiologist physical status I or II, scheduled for elective surgery of less than 30 min under general anesthesia through LMA. These 90 patients were randomized by computer-generated and sealed opaque envelope method into three equal groups, according to the muscle relaxant given, with 30 patients (n = 30) each, after the induction of anesthesia with fentanyl. Atracurium group (group A) received a bolus of atracurium 0.15 mg/kg diluted in 2 ml of 0.9% sodium chloride intravenously before propofol injection and 2 ml of 0.9% sodium chloride after propofol injection. Succinylcholine group (group S) received 2 ml of 0.9% sodium chloride before propofol injection and a bolus of succinylcholine 0.25 mg/kg diluted in 2 ml of 0.9% sodium chloride intravenous after propofol injection. Control group (group C) received 2 ml of 0.9% sodium chloride before and after propofol injection. Two minutes after propofol injection, one disposable lubricated, semi-inflated classic LMA with appropriate size was inserted by an experienced anesthesiologist who was unaware of the drug used for injection and patient groups. Moreover, in the patient groups, a uniform general anesthesia technique was applied to all patients. The primary outcome was ease and reactions to LMA insertion and postoperative sore throat. The secondary outcome was hemodynamic changes, heart rate and mean arterial blood pressure before and after LMA insertion and postoperative myalgia. Results The result of this study reveals that the first attempt in LMA insertion was successful in up to 27 (90%) patients in group S, whereas in only 23 (83.3%) patients in group A and 16 (60.0%) patients in group C. The difference was statistically significant (P<0.001). Postoperative sore throat occurred in 11 (36.7%) of patients of control group, which was statistically significantly more than that in the studied groups. Postoperative myalgia was found in 12 (40%) patients in the succinylcholine group, which was statistically significant more than that in groups A and C (P=0.001). However, there was no difference in apnea times among all the groups. There was no significant difference in hemodynamic changes among all groups, although total propofol consumption was statistically highly significantly more in the control group (P<0.001). Conclusion The concurrent use of minidose muscle relaxant with propofol and fentanyl significantly reduces the occurrence of airway reflexes, increases the success rate of LMA insertion, and decreases the incidence of postoperative sore throat. However, minidose of succinylcholine has a far better effect than minidose of atracurium with significant postoperative myalgia.

A randomized controlled trial to compare preemptive analgesic efficacy and safety of pregabalin and gabapentin for succinylcholine-induced myalgia

Background:Succinylcholine is a drug of choice for rapid induction of anesthesia but produces postoperative myalgia. Preemptive analgesia is intended to decrease perception of pain before exposure to painful stimuli. Pregabalin and gabapentin, analogs of the inhibitory neurotransmitter gamma aminobutyric acid, are effective in several models of neuropathic pain, incisional, inflammatory, and formalin-induced injury. However, the data available on their preemptive analgesic efficacy in succinylcholine myalgia are sparse. This study was designed to compare the preemptive analgesic efficacy and safety of pregabalin and gabapentin.Materials and Methods:This randomized clinical trial included 120 surgical patients of either sex, between 18 and 70 years, and of American Society of Anesthesiologists-I/II grade. Patients were randomly allocated to control and test groups; received respective treatments 30 min before induction of anesthesia. Myalgia and pain scores were recorded using the myalgia scale and visual analog/facial rating scale at awakening at 6, 12, 18, and 24 h, respectively. Postoperative analgesic requirement over 24 h was recorded. Data were analyzed using OpenEpi (Andrew G. Dean and Kevin M. Sullivan, Atlanta, GA, USA) statistical softwares.Results:Significantly lower pain scores were observed in the pregabalin group at 6, 12, and 24 h, and in gabapentin group at 24 h as compared to control and placebo (P < 0.05). They were however found to be equianalgesic when compared to each other (P > 0.05). Pregabalin-treated patients were more comfortable throughout with significantly less postoperative myalgia and analgesic requirement (P < 0.05).Conclusions:Results strongly suggest the preemptive analgesic efficacy of a single oral dose of pregabalin and gabapentin over diclofenac in postoperative myalgia and pain management. However, on the basis of safety profile, pregabalin may be preferred over gabapentin in succinylcholine-induced myalgia.

Effect of Low Dose Magnesium Sulphate on Succinylcholine Induced Fasciculations &amp; Postoperative Myalgia

Effect of Low Dose Magnesium Sulphate on Succinylcholine Induced Fasciculations &amp; Postoperative Myalgia

Succinylcholine-Induced Postoperative Myalgia: Etiology and Prevention

Succinylcholine-Induced Postoperative Myalgia: Etiology and Prevention

Optimal dose of succinylcholine for laryngeal mask airway insertion: systematic review, meta-analysis and metaregression of randomised control trials

ObjectivesTo evaluate the optimal dose of succinylcholine for laryngeal mask airway (LMA) insertion and all related morbidities.DesignSystematic review, meta-analysis and metaregression of randomised controlled trials (RCTs).Data source and study eligibility...

Effects of low-dose ketamine on succinylcholine-induced postoperative myalgia in outpatient surgeries: a randomized, double-blind study.

ObjectiveDespite the many complications of succinylcholine, it is still widely used as a superior muscle relaxant for rapid sequence induction. One of these complications is postoperative myalgia (POM). The aim of this study was to investigate the prophylactic effect of low-dose ketamine on the incidence and severity of POM.Materials and methodsIn this double-blind clinical study, a total of 148 patients scheduled for general anesthesia were randomly divided into two equal groups. Initially, in Group K, 0.5 mg/kg of ketamine was injected intravenously, whereas in Group N, the same volume (5 mL) of normal saline was injected. Thereafter, anesthesia was induced in all patients, by injecting 1.5 mg/kg of fentanyl and 2 mg/kg of propofol intravenously. Following the loss of eyelid reflex, 1.5 mg/kg of succinylcholine was injected intravenously as a muscle relaxant and then the patients were intubated. POM was defined as a pain with no surgical interferences, and its intensity was graded based on a four-point scale. The incidence and severity of myalgia were assessed by a blinded observer 24 hours after surgery.ResultsIn terms of demographic data, the results of this study showed that there is no significant difference between patients in both groups (P>0.05). Overall, the incidence of POM in Group K was significantly less, when compared with Group N (P<0.05), but both groups were comparable based on the grade 2 of POM. After the induction of anesthesia, the systolic and diastolic blood pressure values were found to reduce in both groups (P<0.05). However, the changes were somehow similar, and repeated measures of variance analysis showed no significant difference in the two study groups (P>0.05).ConclusionThe addition of 0.5 mg/kg of ketamine to propofol for the induction of anesthesia can be effective in reducing the incidence of low-grade POM.

Prophylactic use of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia: a randomized, double-blinded, placebo-controlled study

Succinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. The present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. Prospective, randomized, placebo controlled, double blinded study. Patients of both genders undergoing elective spine surgery were randomly assigned to two groups. Patients in Group P (pregabalin group) received 150mg of pregabalin orally 1h prior to induction of anesthesia with sips of water and patients in Group C (control group) received placebo. Anesthesia was induced with fentanyl 1.5mcg/kg, propofol 1.5-2.0mg/kg followed by succinylcholine 1.5mg/kg. The intensity of fasciculations was assessed by an observer blinded to the group allotment of the patient on a 4-point scale. A blinded observer recorded postoperative myalgia grade after 24h of surgery. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. Demographic data of both groups were comparable (p>0.05). The incidence of muscle fasciculation's was not significant between two groups (p=0.707), while more patients in group C had moderate to severe fasciculation's compared to group P (p=0.028). The incidence and severity of myalgia were significantly lower in group P (p<0.05). Pregabalin 150mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.

Risk factors for development of succinylcholine-induced postoperative myalgia

Objective To determine the risk factors for development of succinylcholine-induced postoperative myalgia. Methods One hundred and fifty-five patients, aged 18-64 yr, of ASA physical status Ⅰ or Ⅱ, with body mass index of 20-30 kg/m2, scheduled for elective craniofacial surgery, were included in the study.Total intravenous anesthesia with propofol or combined intravenous-inhalational anesthesia with sevoflurane was performed during surgery.The patients were divided into 2 groups according to whether or not myalgia occurred within 24 h after surgery: myalgia group and non-myalgia group.Factors including gender, age, body weight, duration of surgery, method of anesthesia, dose of succinylcholine, preinjection of lidocaine or nondepolarizing muscular relaxants during induction of anesthesia, use of hormone(dexamethasone or methylprednisolone)and nonsteroidal analgesics(parecoxib sodium)during surgery, and consumption of fentanyl were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors for development of succinylcholine-induced postoperative myalgia. Results Forty-one patients developed postoperative myalgia, and the incidence of myalgia was 27.2%.The results of logistic analysis indicated that succinylcholine <1.5 mg/kg and no preinjection of lidocaine were closely correlated with the development of postoperative myalgia induced by succinylcholine. Conclusion Succinylcholine<1.5 mg/kg and no preinjection of lidocaine are the risk factors for development of succinylcholine-induced postoperative myalgia in the patients. Key words: Succinylcholine; Fibromyalgia; Postoperative complications; Risk factors

Evaluation of prophylactic Effect of Remifentanil on Succinylcholine-Induced Myalgia in Humans

Purpose: To assess the efficacy of remifentanil in preventing succinylcholine-induced myalgia in humans.Methods: Sixty healthy adults scheduled for elective surgery under general anesthesia were enrolled in a double-blind study and randomly allocated to two groups of thirty patients. Patients in Group I (remifentanil group) were pretreated with remifentanil 1 ìg/kg one minute prior to induction of anesthesia, while patients in Group II (saline group) received an equivalent volume of saline. Anesthesia was induced in both groups with fentanyl 1 µg/kg, propofol 2.0 mg/kg and succinylcholine 1.5 mg/kg. Postoperative myalgia was assessed 12, 24, and 48 h after induction and graded as nil, mild, moderate, or severe.Results: Fifty nine patients completed the study. The demographic data for both groups were comparable (p &gt; 0.05). Postoperative myalgia at 12, 24, and 48 h after induction were 34.5, 34.5 and 14.1 % in group I, and 60, 53.4 and 30 % in group II, respectively (p &gt; 0.05).Conclusion: Prophylactic use of remifentanil 1 µg/kg intravenously is ineffective in the prevention of postoperative myalgiaKeywords: Remifentanil, Succinylcholine, Myalgia, Propofol, Prophylaxis

Prophylactic use of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia: a randomized, double-blinded, placebo-controlled study

BackgroundSuccinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. ObjectiveThe present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. DesignProspective, randomized, placebo controlled, double blinded study. Materials and methodsPatients of both genders undergoing elective spine surgery were randomly assigned to two groups. Patients in Group P (pregabalin group) received 150mg of pregabalin orally 1h prior to induction of anesthesia with sips of water and patients in Group C (control group) received placebo. Anesthesia was induced with fentanyl 1.5mcg/kg, propofol 1.5–2.0mg/kg followed by succinylcholine 1.5mg/kg. The intensity of fasciculations was assessed by an observer blinded to the group allotment of the patient on a 4-point scale. A blinded observer recorded postoperative myalgia grade after 24h of surgery. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. ResultsDemographic data of both groups were comparable (p>0.05). The incidence of muscle fasciculation's was not significant between two groups (p=0.707), while more patients in group C had moderate to severe fasciculation's compared to group P (p=0.028). The incidence and severity of myalgia were significantly lower in group P (p<0.05). ConclusionPregabalin 150mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.

Comparing Patient Satisfaction and Intubating Conditions Using Succinylcholine or Low-Dose Rocuronium for Rigid Bronchoscopy: A Randomized Study

Despite its serious side effects, succinylcholine is commonly used for neuromuscular relaxation in short procedures, such as rigid bronchoscopy and tracheobronchial interventions. The application of low-dose rocuronium reversed by low-dose sugammadex might be a modern alternative. The aim of this study was to compare patient satisfaction, incidence of postoperative myalgia (POM) as well as intubating conditions of these two muscle relaxants for rigid bronchoscopy. A single-center, prospective-randomized, blinded study of 95 patients, scheduled for rigid bronchoscopy and tracheobronchial intervention was conducted. The patients were anesthetized with propofol, remifentanil and either low-dose succinylcholine (S) (0.5 mg/kg) or low-dose rocuronium (0.25 mg/kg) with sugammadex (RS) (0.5 mg/kg). All patients were evaluated on the first and second postinterventional day for their satisfaction with the treatment (rigid bronchoscopy) using a Numeric Analog Rating Scale (NAS 0-10) and the presence and severity of POM (NAS 1-4). Intubating conditions were assessed as excellent, good, or poor on the basis of position of vocal cords and reaction to insertion of the rigid bronchoscope. Patients in the S group were less satisfied with the treatment than patients in RS group (72.7 vs. 93.7%, p = 0.007). The incidence of POM on the first day after intervention was significantly higher in the S group then in the RS group (56.9% vs. 4.3%, p < 0.001). Although the intubation was faster (p < 0.001) and the intubating conditions significantly superior (p < 0.003) with succinylcholine, acceptable conditions were also achieved with low-dose rocuronium in 75% of patients. The anesthetic drug costs were significantly higher in the RS group then in the S group (p < 0.001). The results suggest that low-dose rocuronium provided better patient satisfaction and less POM. But with the use of low-dose succinylcholine, the intubating conditions are more comfortable, and it is less expensive than rocuronium/sugammadex.

The Effect of Defasciculating Doses of Pancuronium and Atracurium on Succinylcholine Neuromuscular blockade

Background:A defasciculating dose of non-depolarizing muscle relaxant administered prior succinylcholine decrease its side effects including fasciculations and postoperative myalgias; however it is believed that the dosage of succinylcholine should be increased when such a pre-treatment is used.Objectives:We hypothesized that a defasciculating dose of pancuronium as a pre-treatment could prolong its duration of effect.Patients and Methods:Forty patients scheduled for elective orthopaedic surgery were consecutively assigned into 5 groups, a first group without pre-treatment (succinylcholine 1 mg/kg) and 4 subsequent groups of pretreatment with atracurium 0.05 mg/kg + succinylcholine 1 or 1.5 mg/kg and pancuronium 7.5 µg /kg + succinylcholine 1 and 1.5 mg/kg. The muscle relaxant effect of succinylcholine was assessed with a force transducer using train of four stimulations every 12 seconds. Kruskall Wallis Anova test was used to compare results.Results:The duration of succinylcholine induced paralysis (1 and 1.5 mg/kg) was significantly prolonged with pre-treatment with pancuronium but succinylcholine 1mg/kg did not reached maximum blockade after pre-treatment with atracurium. After pancuronium, full recovery after succinylcholine 1.5 and 1 mg/kg occurred respectively after 18 and 15 minutes. P < 0.05 vs. 12 minutes for succinylcholine 1mg/kg alone.Conclusions:This study highlights potentiation effect of a defasciculating dose of pancuronium on succinylcholine paralysis suggesting the lack of justification to increase succinylcholine dosage.

Effect of repeat bolus dose of propofol on succinylcholine-induced fasciculations and myalgia

Background: Succinylcholine-induced fasciculations and myalgia are common and troublesome for the patients. A few studies have used propofol to minimize succinylcholine-induced fasciculations and myalgia, but none of these have used a repeat bolus dose. Materials and Methods: A prospective, randomized, double blind study was designed to assess the effect of a repeat bolus dose of propofol on succinylcholine-induced fasciculations and myalgia. Ninety adult patients scheduled for elective surgery under general anesthesia were selected by computer-generated random numbers and allocated to one of the three equal groups randomly. Anesthesia was induced with intravenous injection of propofol 2 mg/kg, followed by administration of succinylcholine 1.5 mg/kg. Immediately after the injection of succinylcholine a repeat bolus of propofol was given as per group. Group I: No repeat dose of propofol; Group II: Repeat propofol bolus of 0.5 mg/kg body weight; Group III: Repeat propofol bolus of 1.0 mg/kg body weight. Muscle fasciculations were observed and graded as nil (0), mild (1), moderate (2), or severe (3). Postoperative myalgia were assessed every 6 hourly for 24 h and then at 48 h and graded as nil (I), mild (II), moderate (III), or severe (IV). Results: The overall incidence of muscle fasciculations was 73 and 33% in Groups II and III, respectively as against 90% in Group I. The incidence of postoperative myalgia was highest (86.67%) in Group I and lowest in Group III (60.0%). Conclusion: The technique of giving repeat bolus dose of propofol immediately after succinylcholine not only decreases the incidence and severity of fasciculations and postoperative myalgia, but also provides hemodynamic stability and satisfactory grade of relaxation for intubation.

Rhabdomyolysis in Bariatric Surgery: a Systematic Review

Rhabdomyolysis (RML) is a rare complication of bariatric surgery. A systematic review was performed to identify risk factors and patient outcomes in morbidly obese patients undergoing bariatric surgery who develop RML. A comprehensive search was performed between January 1990 and March 2012 using relevant MeSH terms. Studies were chosen based on predefined inclusion criteria. RML was defined as a creatine kinase of more than 1,000IU/L. The parameters assessed included patient characteristics of the RML population, type of bariatric surgery performed, operating time, complications, presentation and diagnosis of RML. Twenty-two studies were analysed which included 11 case reports, two case series, six prospective and three retrospective comparative studies. Overall 145 patients with RML were reported following bariatric surgery. Acute renal failure was found in 20 patients (14%) and was significantly more likely to occur in patients with postoperative muscle pain (p < 0.05). The mortality rate after renal failure was 25% (n = 5). In the comparative studies, 87 RML patients were compared with 325 non-RML patients. The RML patients were more likely to be male, had a greater mean body mass index (BMI) (52 vs 48kg/m(2), p < 0.01) and underwent a longer operation (255 vs 207min, p < 0.01) compared to non-RML patients. Risk factors of developing RML following bariatric surgery include male gender, elevated BMI and prolonged operating time. Patients with a biochemical diagnosis of RML and postoperative myalgia after bariatric surgery are at increased risk of developing acute renal failure and mortality. These patients must be identified and treated promptly.