Suxamethonium, postoperative

Statins, see HMG Co-A reductase inhibitors Steroids, see Glucocorticoids Stimulants, in ADHD, 31.4 Sugammadex, 32.275 Sulfonamide derivatives, hypersensitivity reactions, 30.252 Sumatriptan, 17.171 Suprofen, nephrotoxicity, 12.88 Suramin, patients with prostate cancer, 20.283 Surgam, gastric reactions, 12.89 Suxamethonium, postoperative myalgia,... 

Apnea of variable duration results from muscle paralysis. The return of spontaneous respiration is normally rapid, but it may be delayed if phase II block develops. This will only be of consequence if it is not detected and spontaneous respiration is permitted before it is adequate. Exacerbation of muscle weakness in Duchenne muscular dystrophy after injection of suxamethonium can lead to delayed respiratory failure postoperatively (29). 

Other measures, much disputed, include the prior injection of diazepam (58,59), procaine or hdocaine (57), vitamin C, suxamethonium itself (10 mg), and aspirin (51,52). The combined use of atracurium 0.05 mg/kg and hdocaine 1.5 mg/kg reduced the incidence of postoperative myalgia to 5% compared with 75% in controls (57). Thiopental, injected immediately beforehand, is also said to have some effect, as is giving the suxamethonium slowly. 

There is an association between (latent) muscular dystrophy (usually of the Duchenne or Becker type) and the production of rhabdomyolysis by suxamethonium (84,85,89,90). Suxamethonium can cause excessive muscle damage in these patients, as manifested not only by severe myoglobinemia and raised serum creatine kinase activity but also by acute exacerbation of muscle weakness postoperatively (SEDA-11, 121) (7,29,84,91,92). Massive potassium release can result in hyperkalemic cardiac arrest. Such patients may also develop features suggestive of the syndrome of malignant hyperthermia (93,94). Suxamethonium should not be used in patients with Duchenne muscular dystrophy or who have a family history suspect for the condition. 

The use of suxamethonium in patients with renal insufficiency was controversial in the 1970s, after some cases of hyperkalemic cardiac arrest in such patients. As several studies did not show exaggerated potassium release, suxamethonium is now considered safe for patients with renal insufficiency, if preoperative hyperkalemia is excluded. The observation of some cases of postoperative hyperkalemia recently prompted a review of the literature (199). The authors found sufficient evidence to support the current consensus suxamethonium can be used in patients with renal insufficiency, but it should not be given if there is pre-existing hyperkalemia doses of suxamethonium should not be given repeatedly, as this can result in sinus bradycardia. 

The problem of suxamethonium-associated postoperative myalgia has been reviewed (214). Key statements are ... 

Donepezil acts primarily as a reversible inhibitor of acetylcholinesterase with a half-life of over 70 hours. Prolonged paralysis lasting several hours and requiring postoperative mechanical ventilation in the intensive care unit has been reported after the use of suxamethonium in a patient taking long-term donepezil (285). 

Manataki AD, Arnaoutoglou HM, Tefa LK, Glatzounis GK, Papadopoulos GS. Continuous propofol administration for suxamethonium-induced postoperative myalgia. Anaesthesia 1999 54(5) 419-22. 

Thiopental can reduce muscle fascicula-tion associated with suxamethonium [3 ]. In 300 ASA I and n patients, who were randomized to suxamethonium immediately after thiopental or 30 seconds later, the onset of fasciculation was earher in the former and the duration of fasciculation was shorter in addition, there was moderate to severe fasciculation in the latter. The relation between fasciculations and postoperative myalgia has not been well defined. The authors did not comment on the incidence and severity of myalgia after surgery. 

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