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Introduction: Laryngeal Mask Airway (LMA) insertion is often associated with complications such as gagging, laryngospasm and mobility of the head and neck while insertion. To overcome this and achieve a smooth insertion, many drugs are tried one of them is being succinylcholine. Aim: To assess the effects of low dose succinylcholine (0.1 mg/kg) on facilitation of LMA insertion to achieve adequate conditions with fewer or no side effects. Materials and Methods: Sixty patients of American Society of Anesthesiologists (ASA) I and II grade were posted for elective surgeries under general anaesthesia with LMA. Patients were randomly allocated into two groups of 30 each. Control group (Group C) received a bolus dose of 2 mL of 0.9% sodium chloride I.V post induction. Study Group (Group S) received a bolus of succinylcholine 0.1 mg/kg diluted in 2 mL of 0.9% sodium chloride I.V post induction. Following activities like jaw relaxation, coughing/gagging, head and limb movements, presence or absence of laryngospasm and duration of apnea were noted and were compared using chi-square test, while performing LMA insertion under general anaesthesia. Results: It was found that the number of incidences of gagging (mild) and coughing (mild) in Group S was 3.33% and 0%, respectively, while it was 23.33% and 26.66% in Group C. It was found that group S had excellent insertion conditions in 94% of patients as compared to 36% of group C (p<0.001). In 93.33% of patients, LMA was inserted in 1st attempt in group S, whereas 40% of patients in group C required more than one insertion attempt and also 93.3% of patients in group S did not require excess propofol, whereas supplement doses of propofol in control group was required in 60% of patients. Conclusion: Low dose succinylcholine provides better LMA insertion conditions with reduced number of attempts, incidences of gagging and coughing. [ABSTRACT FROM AUTHOR]

Background: Succinylcholine is a depolarizing agent used for rapid sequence intubation (RIS). While the agent is the most widely used drug of choice in most emergency departments (EDs), the adverse effect profile is lengthy compared to nondepolarizing paralytic agents included rocuronium and vecuronium. Objectives: Our objective in this analysis is to detect potential safety signals and differences in safety related outcomes between patients that received succinylcholine compared to those that received rocuronium or vecuronium when undergoing RSI. Specifically, we asked whether there was a difference in all-cause mortality, whether succinylcholine was used in patient later found to have contraindications to the medication, as well as differences in the rates of rescue airway or difficult airway algorithms utilized. Methods: We utilize two clinical cases as a framework to review adverse events among ED patients undergoing RSI when using succinylcholine compared to nondepolarizing agents over a 7 years' period at our institution as part of a quality review project. The review is retrospective and does not allow us to link adverse events specifically with drug but, instead, considers aggregate level event frequency. Results: From January 31, 2013, to January 31, 2018, there were 36,059 intubations with paralytics in the ED (75.39% with succinylcholine and 24.61% with rocuronium or vecuronium). There was no evidence of death or associated adverse events in 98.49% of patients. Of 36,059 intubations, 14 patients expired, representing 0.039% of all RSI encounters. There were 39/100,000 total deaths during RSI events. There was a higher rate of mortality in the combined vecuronium/rocuronium group (90/100,000) compared to the sample of patients intubated with succinylcholine (22/100,000). Conclusions: While the succinylcholine adverse effect profile is concerning, data from our institution does not support removal of the agent as an available option for RSI as the mortality rate among patients receiving succinylcholine was lower than that of patients receiving non-depolarizing agents. Patient level data will be needed in future work to further understand why the all-cause mortality rate was higher in the group receiving rocuronium or vecuronium and whether those patients had increased risk of mortality from underlying disease at time of presentation. [ABSTRACT FROM AUTHOR]

Intraoperative anaphylactic reactions may range from mild, erythema-like to anaphylactic shock, with tension crash and bronchospasm. The substances considered to be most responsible for the occurrence of intraoperative allergic reactions are neuromuscular blocking agents, antibiotics and latex. Recent studies have identified a new receptor, Mas-Related G-Protein-coupled Receptor X2 (MRGPRX2), considered as a target for some neuromuscular blockers such as atracurium, rocuronium or fluoroquinolone, resulting in pseudoallergic or anaphylactoid reactions. Induction of anesthesia can use both depolarizing myorelaxants, useful especially in emergency situations, in the patient with gastric plenitude or at high risk of intubation, and non-depolarizing myorelaxants such as atracurium, cisatracurium and rocuronium. Succinylcholine has a short time of action and it is rapidly metabolized. Atracurium, although having a slightly longer time to action, has the benefit of a low risk of increased levels of potassium in blood, which is extremely important in patients with cardiac pathology or associated kidney diseases. The present study compared the side effects of systemic anesthesia with succinylcholine vs. atracurium. [ABSTRACT FROM AUTHOR]

Children's Succinylcholine 100mg, is manufactured in the Liorad Laboratories Base Business Unit, it is the objective of this work to characterize the adverse reactions to succinylcholine in the Cuban child population during the usual clinical practice. A review of the scientific literature was carried out, in the period that it is evaluated, there are no publications of suspected reactions of the national product, a claim received for failure of effectiveness was evaluated, which did not proceed, there was no withdrawal of this product and in postproduction visits its use was positively evaluated. A descriptive, cross-sectional observational study was carried out; As a series of cases, based on spontaneous reports of adverse reactions to the National Database, other information related to the patient and the product that appears therein was taken into account. The study universe consisted of 91 notifications sent from June 2015 to june 2019. Suspected reactions were classified according to frequency, intensity and imputability. The highest percentage of reactions reported corresponds to bradycardia, the cardiovascular system was the most affected. The highest number of adverse reactions was classified as: occasional (91.2%), which corresponded with serious reactions with favorable evolution (no fatal outcome was reported) and with the classification of probable. The adverse reactions reported are those described for this drug. It is concluded that the present work allowed characterizing the adverse reactions to succinylcholine 100mg in the Cuban child population, describing its introduction in the national market as safe. [ABSTRACT FROM AUTHOR]

Succinylcholine is a commonly used medication in all aspects of anesthetic care, and there are a number of known side effects and complications associated with its use. However, when succinylcholine is used emergently, anesthesia providers must remain vigilant to undiagnosed conditions that pose additional risks to patients. We report the use of succinylcholine to treat acute, refractory laryngospasm after extubation leading to prolonged neuromuscular paralysis. There are unique challenges presented by this case including the risk of anesthesia awareness with recall due to the cognitive biases that prevent the clinical diagnosis of pseudocholinesterase deficiency. [ABSTRACT FROM AUTHOR]

Objectives/Aim: This study evaluates the relationship between neuromuscular blocking drug administered and transport time following laparoscopic pyloromyotomy. Background: Infants with pyloric stenosis have indication for rapid sequence induction. While succinylcholine has rapid onset and short duration, its use in children may be associated with rare serious adverse effects. Rocuronium is a widely accepted alternative, but its duration could contribute to delay at surgery end. Methods: Infants undergoing laparoscopic pyloromyotomy at Loma Linda University Medical Center Children's Hospital from January 2006 to July 2011 were studied retrospectively. Only term infants receiving propofol induction, sevoflurane maintenance, no intraoperative opioid, and rocuronium, succinylcholine, or both were included. The primary outcome measure was time to transport after surgery stop as a measure of recovery from both anesthesia and relaxant. Data was analyzed for relationships between drug choice and time to transport. Results: Data from 246 patients was analyzed. Patients were similar in all groups. Time to transport was not affected by doses of propofol or neuromuscular blocking drug, anesthesia to surgery end interval or surgery length. Time to transport (minutes median, interquartile range) was 13 (7-21) in patients receiving only succinylcholine compared to 18 (11-24) in those receiving only rocuronium ( P = 0.03). Conclusions: For laparoscopic pyloromyotomy in term infants using propofol, sevoflurane and no intraoperative opioid, succinylcholine may be the best neuromuscular blocking drug choice, provided no contraindication is present. However, based on the small difference in time to transport, rocuronium as administered herein may be a reasonable alternative preferred by some clinicians. [ABSTRACT FROM AUTHOR]

Background: Magnesium sulfate and propofol have been found to be effective against succinylcholine-induced fasciculations and myalgia, respectively, in separate studies. A prospective randomized double blind controlled study was designed to assess the effect of a combination of magnesium sulfate with propofol for induction of anesthesia on succinylcholine-induced fasciculations and myalgia. Materials and Methods: Randomly selected 60 adult patients scheduled for elective surgery under general anesthesia were allocated to one of the two equal groups by draw of lots. The patients of MG Group were pretreated with magnesium sulfate 40 mg/kg body weight in 10 ml volume, while patients of NS group were given isotonic saline 0.9% in the same volume (10 ml) intravenously slowly over a period of 10 min. Anesthesia was induced with fentanyl 1.5 mcg/kg and propofol 2 mg/kg, followed by administration of succinylcholine 2 mg/kg intravenously. Muscle fasciculations were observed and graded as nil, mild, moderate, or severe. Postoperative myalgia was assessed after 24 h of surgery and graded as nil, mild, moderate, or severe. Observations were made in double blind manner. Results: Demographic data of both groups were comparable (P > 0.05). Muscle fasciculations occurred in 50% patients of MG group versus in 100% patients of NS group with a significant difference (P < 0.001). After 24 h of surgery, no patient of MG group and 30% patients of NS group had myalgia with a significant difference (P < 0.002). Conclusion: Magnesium sulfate 40 mg/kg intravenously may be used with propofol for induction of anesthesia to control succinylcholine-induced fasciculations and myalgia. [ABSTRACT FROM AUTHOR]

Introduction: There has been a significant increase in premedication use for neonatal intubation in the UK over the past decade. We aimed to determine the adverse events during neonatal intubation using the most commonly used premedication regimen in the UK.Discussion: We prospectively studied all intubations performed using morphine, suxamethonium and atropine during a 3-month period in three UK tertiary neonatal units. Premedication was administered for 87/93 (94%) of intubations. Median time taken to prepare premedication was 16 min (IQR 10-35). Median time to successful intubation was 5 min (IQR 2-9) following premedication. Median lowest recorded oxygen saturation after administration of premedication was 65% (IQR 39-85). A bradycardia in the range 61-99/min accompanied the procedure in 24/93 (26%) intubations, with a median duration of bradycardia of 8 s (IQR 1-10).Conclusion: Despite the widespread move to premedication for neonatal intubation, many deficiencies in everyday practice remain. The rate of haemodynamic complications is high in this commonly used premedication regimen. This study shows that there are important factors to control at the local level in terms of timely preparation and administration of premedication drugs, training and supervision of staff carrying out this high-risk procedure. [ABSTRACT FROM AUTHOR]

The article reports on a U.S. Centers for Medicare and Medicaid Services (CMS) survey which shows deficiencies in malignant hyperthermia (MH) response at U.S. hospitals and health systems in 2011-2015. It states that most problems involved an inadequate supply of dantrolene and of staff training to obtain and administer the drug to avert deadly outcomes. The article also notes the stocking of succinylcholine without patient-profile capabilities and the absence of an MH kit.