Succinylcholine apnea anesthesiology asa publications. It can be inherited, or it can appear spontaneously in a person with no family history. A variety of pathologic conditions, physiologic alterations, and medications also can lower plasma pseudocholinesterase activity. Each healthcare facility and its staff determine the appropriate medications required to safely manage routine and unexpected patient anesthesia needs. Delayed recovery from paralysis by succinylcholine in.
Adequate spontaneous respiration was reestablished in an average period of ten minutes after the injection. Free full text similar articles prolonged succinylcholine apnoea reversed by prostigmin. Succinylcholine daviss drug guide for rehabilitation. Suxamethonium succinylcholine apnoea occurs when a patient. Sep 01, 2002 read prolonged apnea following succinylcholine administration in undiagnosed acute organophosphate poisoning, acta anaesthesiologica scandinavica on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips.
This condition, succinylcholine apnea, is believed to exist in 1 in. Pseudocholinesterase deficiency is an autosomal recessive inherited blood plasma enzyme abnormality in which the bodys production of butyrylcholinesterase bche. The intermittent use of succinylcholine to keep the patient just apneic is called the in and out of apnea technique and has several advantages. Interactions for succinylcholine chloride specific drugs. Fresh frozen plasma for succinylcholine apnoea time to. Succinylcholine is a depolarizing muscle relaxant which causes a sustained activation of postjunctional nicotinic acetylcholine receptors at the neuromuscular junction, thereby leading to muscle contraction which is normally followed by muscle relaxation within 6090 seconds as persistent depolarization prevents subsequent action potential generation. With the intensified use of organophosphorous insecticides by the general population and the increasing use of succinylcholine in general as well as in dental surgery, we would like to point out a problem that has come to our attention. Succinylcholine has mild interactions with at least 49 different drugs.
Succinylcholine apnea in an unusual case posted for. Prolonged apnea after administration of succinylcholine nejm. Based on theoretical considerations, benumof et al. Pseudocholinesterase deficiency is an inherited enzyme abnormality that results in abnormally slow metabolic degradation of exogenous choline ester drugs such as succinylcholine. Skeletal muscle relaxants knowledge for medical students.
Jul 14, 2003 although prolonged respiratory insufficiency after succinylcholine administration is rare, the above case reiterates the need for monitoring neuromuscular function and highlights the risks associated with empirical use of muscle relaxants. Succinylcholine was repeatedly administered to 60 male patients as an adjuvant to electroshock therapy. Suxamethonium apnoea occurs when a person has a low level of the enzyme cholinesterase also known as butyrylcholinesterase or pseudocholinesterase in the bloodstream. Anectine succinylcholine chloride is an ultra shortacting depolarizingtype, skeletal muscle relaxant for intravenous iv administration. Succinylcholine is a quaternary ammonium compound and depolarizing agent with shortterm muscle relaxant properties. Call your doctor right away if you have a fast heartbeat, fast breathing, fever, or spasm or stiffness of the jaw muscles. Succinylcholine is used during labor and obstetric delivery by cesarean section.
Keep a list of all your medications with you, and share the. Succinylcholineinduced prolonged apnea in a 3weekold. Reversal of succinylcholine induced apnea with an organophosphate scavenging recombinant butyrylcholinesterase brian c. Succinylcholine definition of succinylcholine by the free. Acquired causes, including liver disease, renal disease, malnutrition, pregnancy.
The drug, however, has serious side effects and a significant number of contraindications. Relation between dose of succinylcholine and duration of apnea 39 2. Mor school of life sciences and the biodesign institute, arizona state university, tempe, arizona, united states of america. Learn succinylcholine with free interactive flashcards. The use of serum cholinesterase in succinylcholine apnoea. Prolonged apnea following succinylcholine administration in.
Get a printable copy pdf file of the complete article 410k, or click on a page image below to browse page by page. Pseudocholinesterase deficiency nord national organization for. Possible decreased plasma cholinesterase activity in patients with severe renal impairment. Succinylcholine has no known severe interactions with other drugs. A crystalline compound, c14h30n2o4, formed by esterification of succinic acid with choline and. Anectine succinylcholine chloride dose, indications. Fifteen patients demonstrating unexpected prolonged apnoea lasting several hours after succinylcholine have been treated by a new preparation of human serum cholinesterase. You will receive an email whenever this article is corrected, updated, or cited in the literature. Quelicin succinylcholine chloride injection, usp is a sterile, nonpyrogenic solution to be used as an ultra shortacting, depolarizing, skeletal muscle relaxant see how supplied for summary of content and characteristics of the solutions. This document does not contain all possible interactions. Fresh frozen plasma for succinylcholine apnoea time to reconsider. Edrophonium 10 mg, given 74 min after succinylcholine, when trainoffour stimulation was characteristic of phase ii block, produced partial antagonism which. Succinylcholineinduced prolonged apnea in a 3weekold newb. There have been rare reports of acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death after the administration of succinylcholine.
Succinylcholine dosage and apneainduced hemoglobin. In particular, patients who carry genetic or acquired deficiency of butyrylcholinesterase, the serum enzyme responsible for succinylcholine hydrolysis, are susceptible to succinylcholineinduced apnea, which manifests as paralysis, lasting hours beyond the normally brief halflife of succinylcholine. Succinylcholine dosage and apneainduced hemoglobin desaturation in patients. Succinylcholine apnea is identified by a blood test. In cases where suxamethonium apnoea is inherited the level of plasma cholinesterase is reduced.
Is there still a role for succinylcholine in contemporary. Succinylcholine an early muscle relaxant mr can cause side effects such as arrhythmias, increased intraocular pressure, prolonged apnea, damaged muscle membranes, hyperkalaemia, triggering malignant pyrexic syndrome, circulatory collapse, etc. In the acquired condition the level of plasma cholinesterase is normal but its activity is reduced. Anticholinesterases were administered in an attempt to antagonize prolonged neuromuscular blockade following the administration of succinylcholine in a patient later found to be homozygous for atypical plasma cholinesterase. Succinylcholine anectine, quelicin daviss drug guide. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. There is a genetic defect that causes a lack of the enzyme that breaks down succinylcholine, a type of anesthesia. Registered users can save articles, searches, and manage email alerts. Recombinant plantderived butyrylcholinesterase was capable of counteracting and reversing apnea in two complementary models of lethal succinylcholine toxicity, completely preventing mortality.
Larrimore, jacquelyn kilbourne, latha kannan, tsafrir s. In 12 patients biochemical genetic examinations confirmed the presence of an atypical serum. When succinylcholine is given to a person with this defect, it continues to suppress breathing long after the general anesthesia has worn off. Dec 26, 20 because prolonged apnea due to pseudocholinesterase deficiency is triggered after mivacurium or succinylcholine administration for muscle relaxation, pseudocholinesterase deficiency is clinically asymptomatic in patients without any previous history of receiving succinylcholine or mivacurium. This process leads to paralysis of all skeletal muscles, starting with the small muscles of the face and paralyzing the diaphragm last. Mar 11, 20 in particular, patients who carry genetic or acquired deficiency of butyrylcholinesterase, the serum enzyme responsible for succinylcholine hydrolysis, are susceptible to succinylcholine induced apnea, which manifests as paralysis, lasting hours beyond the normally brief halflife of succinylcholine. Suxamethonium chloride an overview sciencedirect topics. Volume 74 issue 1 succinylcholineinduced prolonged apnea in a 3weekold newb. Succinylcholine has moderate interactions with at least 182 different drugs. The management of succinylcholine apnoea wiley online library. Anaesthesia was maintained with nitrous oxide, oxygen and. Butyrylcholinesterase bche genotyping for postsuccinylcholine apnea in an australian population article in clinical chemistry 498.
Anectine, suxamethonium succinylcholine dosing, indications. Reduced plasma cholinesterase activity may occur in pregnancy. May, 2019 anectine succinylcholine chloride is an ultra shortacting depolarizingtype, skeletal muscle relaxant for intravenous iv administration. Based on a mathematical model of hemoglobin desaturation during apnea, benumof et al. Succinylcholine and pseudocholinesterase jama jama network. You can manage this and all other alerts in my account. Skeletal muscle relaxants are drugs that block the neuromuscular junction nmj by binding to acetylcholine ach receptors located on it. Cholinesterase destroys suxamethonium, so people with low levels of cholinesterase cannot destroy the drug as quickly as other people, hence the drug effects last longer. The succinylcholine drip is resumed intermittently whenever it is needed to maintain the apnea.
Choose from 203 different sets of succinylcholine flashcards on quizlet. Prolonged apnea following succinylcholine administration. Since each patient received between 5 and 25 treatments, the relationship between intravenously injected doses of succinylcholine and duration of complete apnea could be measured. Register for a free account existing user log in existing user log in. Causes and prevention of prolonged apnea with succinylcholin. All other personnel were blinded as to the patients treatment group. Succinylcholine has serious interactions with at least 28 different drugs. Succinylcholine induced apnea you will receive an email whenever this article is corrected, updated, or cited in the literature. Succinylcholine, the only depolarizing nmjblocking drug, binds to ach. Anectine succinylcholine chloride injection, usp warning risk of cardiac arrest from hyperkalemic rhabdomyolysis.
Succinylcholine is a depolarizing muscle relaxant that has been used for rapid sequence induction and for procedures requiring only a brief duration of muscle relaxation since the late 1950s. Pdf anticholinesterases were administered in an attempt to antagonize. Humans as well as other species have a specific acetylcholinesterase that is present at the cholinergic junctions of the nervous system and. Not all cases of prolonged apnea following the use of succinylcholine can be explained by genetic variants of serum cholinesterase 40 2. Delayed recovery from paralysis by succinylcholine in patient. This study of a protein antidote validates the feasibility of protection and treatment of overdose from succinylcholine as well as other biologically. Nov 14, 2017 pseudocholinesterase deficiency is an inherited enzyme abnormality that results in abnormally slow metabolic degradation of exogenous choline ester drugs such as succinylcholine. Of the 60 patients, 51 had the usual or normal type of serum cholinesterase, as defined by inhibition tests with.
Pdf reversal of succinylcholine induced apnea with an. This is done to help with tracheal intubation or electroconvulsive therapy. Apnea in succinylcholinemodified electroshock therapy. Patient was shifted succinylcholine apnea in an unusual case posted for dentigerous cyst excision r aravindan and jamila consultant anaesthesiologist, senior resident, apollo hospitals, 21, greams lane, off greams road, chennai 600 006, india. Oct 22, 2018 possible decreased plasma cholinesterase activity in patients with severe renal impairment. I remembered well the teaching i received as a junior that succinylcholine apnoea never killed anybody but attempts to treat it might. People who have this abnormality may be sensitive to certain anesthetic drugs, including the muscle relaxants succinylcholine and mivacurium as well as other ester local anesthetics. If succinylcholine was a new drug today it is probable that the fda would not give it approval.
Suxamethonium chloride, also known as suxamethonium or succinylcholine, is a medication used to cause shortterm paralysis as part of general anesthesia. When anesthetic drugs such as succinylcholine or mivacurium are administered to a. Prolonged succinylcholine apnoea reversed by prostigmin. Of the 60 patients, 51 had the usual or normal type of serum cholinesterase, as defined by inhibition tests. Lippincott journals subscribers, use your username or email along with your password to log in.
Recently, second thoughts about the margin of safety associated with succinylcholine in doses. Geyer bc, larrimore ke, kilbourne j, kannan l, mor ts 20 reversal of succinylcholine induced apnea with an organophosphate scavenging recombinant butyrylcholinesterase. Succinylcholine chloride monograph for professionals. Because prolonged apnea due to pseudocholinesterase deficiency is triggered after mivacurium or succinylcholine administration for muscle relaxation, pseudocholinesterase deficiency is clinically asymptomatic in patients without any previous history of receiving succinylcholine or mivacurium. This medicine may cause a very bad and sometimes deadly problem called malignant hyperthermia. Look up information on diseases, tests, and procedures. It is given either by injection into a vein or muscle. Succinylcholine chloride is a white, odorless, slightly bitter powder and very soluble in water. The use of blood products as a treatment of succinylcholine apnoea has been well documented 3. This case also revisits the use of ffp to treat prolonged succinylcholine blockade. Feb 01, 2020 this medicine may cause a very bad and sometimes deadly problem called malignant hyperthermia. Edrophonium 10 mg, given 74 min after succinylcholine, when trainoffour stimulation was characteristic of phase ii block, produced partial antagonism which was not.
Succinylcholine binds to nicotinic receptors at the neuromuscular junction and opening the ligandgated channels in the same way as acetylcholine, resulting in depolarization and inhibition of neuromuscular transmission. Pretreatmentagentsshouldbegiven3minutespriortointubation canbe giveninanyorder drug dose indication othernotes. Use succinylcholine during pregnancy only if clearly needed. Succinylcholineinduced prolonged apnea in a 3weekold newborn. Assess respiration, and notify physician or nursing staff immediately if patient exhibits any interruption in respiratory rate apnea or signs of respiratory failure rapid labored breathing, cyanosis, confusion, irritability, sleepiness, headache, oxygen desaturation. Concerns about the safety of paralytics such as succinylcholine to facilitate endotracheal intubation limit their use in.
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