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Suxamethonium side effects- Indications and alternatives
- mark p crowley (11 May 2007)
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mark p crowley, Anaesthetist Warwick Hospital
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My thanks to Dr's Holak and colleagues for their recent case report of an unusually high rise in serum potassium concentration following the administration of suxamenthonium 1.5mg/kg to a patient who recently had recieved chemoradiotherapy. The debate about the use and role of suxamethonium and potential alternative agents has raged for decades. Undoutedly suxamethonium has many advantages over other drugs for the rapid muscular relaxation that it produces for tracheal intubation and for the rapid offset of its effects. However its use comes at a price. Myalgia, hyperkalaemia, raised intraoccular pressure, anaphylaxis and malignant hyperpyrexia are recognised side effects of its use. Alternative agents such as rocuronium used at the appropriate dose can reproduce the time to ideal intubating conditions that suxamethonium gives us. I think suxamethonium still has a place in clinical practice in selected clinical scenarios. A difficult intubation and/or rapid sequence induction are a couple of a handfull of indications where i routinely use this drug. This patient does seem to have a few risk factors that may lend to the use of a fast acting depolarising agent such as obesity, non insulin dependent diabetes and bowel surgery. However given that the authors do not mention a potential or known difficult airway, risk factors for pulmonary aspiration and the fact that the case was an elective (scheduled) lower gastrointestinal case I wondered why suxamethonium was selected as the agent of choice? Could an alternative safer neuromuscular blocker with not such an extensive list of recognised side effects have been used in this case or were there alternative indications for its use in this instance? Conflict of Interest:None declared |
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