Oct 22, 2018 possible decreased plasma cholinesterase activity in patients with severe renal impairment. Succinylcholine chloride is a white, odorless, slightly bitter powder and very soluble in water. Fifteen patients demonstrating unexpected prolonged apnoea lasting several hours after succinylcholine have been treated by a new preparation of human serum cholinesterase. Prolonged apnea following succinylcholine administration.
The management of succinylcholine apnoea wiley online library. In 12 patients biochemical genetic examinations confirmed the presence of an atypical serum cholinesterase. Succinylcholine dosage and apneainduced hemoglobin. In 12 patients biochemical genetic examinations confirmed the presence of an atypical serum.
Look up information on diseases, tests, and procedures. The use of blood products as a treatment of succinylcholine apnoea has been well documented 3. The drug, however, has serious side effects and a significant number of contraindications. 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. 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. Acquired causes, including liver disease, renal disease, malnutrition, pregnancy. Lippincott journals subscribers, use your username or email along with your password to log in. 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. The use of serum cholinesterase in succinylcholine apnoea. Free full text similar articles prolonged succinylcholine apnoea reversed by prostigmin. Suxamethonium succinylcholine apnoea occurs when a patient. You will receive an email whenever this article is corrected, updated, or cited in the literature. It is given either by injection into a vein or muscle. Succinylcholine is a quaternary ammonium compound and depolarizing agent with shortterm muscle relaxant properties.
Succinylcholine has mild interactions with at least 49 different drugs. If succinylcholine was a new drug today it is probable that the fda would not give it approval. Based on a mathematical model of hemoglobin desaturation during apnea, benumof et al. 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. 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. Suxamethonium chloride an overview sciencedirect topics. Anaesthesia was maintained with nitrous oxide, oxygen and. You can manage this and all other alerts in my account. There is a genetic defect that causes a lack of the enzyme that breaks down succinylcholine, a type of anesthesia.
Anectine succinylcholine chloride injection, usp warning risk of cardiac arrest from hyperkalemic rhabdomyolysis. The succinylcholine drip is resumed intermittently whenever it is needed to maintain the apnea. Get a printable copy pdf file of the complete article 410k, or click on a page image below to browse page by page. Pdf anticholinesterases were administered in an attempt to antagonize. 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.
Use succinylcholine during pregnancy only if clearly needed. Succinylcholine, the only depolarizing nmjblocking drug, binds to ach. Succinylcholine is used during labor and obstetric delivery by cesarean section. Reduced plasma cholinesterase activity may occur in pregnancy.
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. Register for a free account existing user log in existing user log in. This is done to help with tracheal intubation or electroconvulsive therapy. Suxamethonium chloride, also known as suxamethonium or succinylcholine, is a medication used to cause shortterm paralysis as part of general anesthesia. Skeletal muscle relaxants are drugs that block the neuromuscular junction nmj by binding to acetylcholine ach receptors located on it. 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. All other personnel were blinded as to the patients treatment group. Fresh frozen plasma for succinylcholine apnoea time to. Pseudocholinesterase deficiency is an autosomal recessive inherited blood plasma enzyme abnormality in which the bodys production of butyrylcholinesterase bche. Is there still a role for succinylcholine in contemporary. Concerns about the safety of paralytics such as succinylcholine to facilitate endotracheal intubation limit their use in.
In cases where suxamethonium apnoea is inherited the level of plasma cholinesterase is reduced. Succinylcholine has moderate interactions with at least 182 different drugs. Not all cases of prolonged apnea following the use of succinylcholine can be explained by genetic variants of serum cholinesterase 40 2. When anesthetic drugs such as succinylcholine or mivacurium are administered to a. What are some other side effects of succinylcholine. Learn succinylcholine with free interactive flashcards.
Succinylcholine chloride monograph for professionals. Recombinant plantderived butyrylcholinesterase was capable of counteracting and reversing apnea in two complementary models of lethal succinylcholine toxicity, completely preventing mortality. 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. Geyer bc, larrimore ke, kilbourne j, kannan l, mor ts 20 reversal of succinylcholine induced apnea with an organophosphate scavenging recombinant butyrylcholinesterase. 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. Delayed recovery from paralysis by succinylcholine in. Feb 01, 2020 this medicine may cause a very bad and sometimes deadly problem called malignant hyperthermia.
Delayed recovery from paralysis by succinylcholine in patient. Succinylcholineinduced prolonged apnea in a 3weekold newborn. Keep a list of all your medications with you, and share the. Pretreatmentagentsshouldbegiven3minutespriortointubation canbe giveninanyorder drug dose indication othernotes. Pseudocholinesterase deficiency nord national organization for. Succinylcholine definition of succinylcholine by the free. A crystalline compound, c14h30n2o4, formed by esterification of succinic acid with choline and. Humans as well as other species have a specific acetylcholinesterase that is present at the cholinergic junctions of the nervous system and. 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. Pdf reversal of succinylcholine induced apnea with an. There have been rare reports of acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death after the administration of succinylcholine. Fresh frozen plasma for succinylcholine apnoea time to reconsider. Succinylcholineinduced prolonged apnea in a 3weekold newb.
Choose from 203 different sets of succinylcholine flashcards on quizlet. It can be inherited, or it can appear spontaneously in a person with no family history. Call your doctor right away if you have a fast heartbeat, fast breathing, fever, or spasm or stiffness of the jaw muscles. Anectine, suxamethonium succinylcholine dosing, indications. Succinylcholine induced apnea you will receive an email whenever this article is corrected, updated, or cited in the literature. Succinylcholine has no known severe interactions with other drugs. 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. Succinylcholine anectine, quelicin daviss drug guide. Skeletal muscle relaxants knowledge for medical students. Succinylcholine daviss drug guide for rehabilitation. This case also revisits the use of ffp to treat prolonged succinylcholine blockade.
Butyrylcholinesterase bche genotyping for postsuccinylcholine apnea in an australian population article in clinical chemistry 498. Relation between dose of succinylcholine and duration of apnea 39 2. Prolonged apnea following succinylcholine administration in. Mor school of life sciences and the biodesign institute, arizona state university, tempe, arizona, united states of america. 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. Anectine succinylcholine chloride is an ultra shortacting depolarizingtype, skeletal muscle relaxant for intravenous iv administration. 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.
Succinylcholineinduced prolonged apnea in a 3weekold. Recently, second thoughts about the margin of safety associated with succinylcholine in doses. 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. Succinylcholine dosage and apneainduced hemoglobin desaturation in patients. Registered users can save articles, searches, and manage email alerts. Succinylcholine apnea is identified by a blood test. Each healthcare facility and its staff determine the appropriate medications required to safely manage routine and unexpected patient anesthesia needs. This study of a protein antidote validates the feasibility of protection and treatment of overdose from succinylcholine as well as other biologically.
Prolonged apnea after administration of succinylcholine nejm. Adequate spontaneous respiration was reestablished in an average period of ten minutes after the injection. Anectine succinylcholine chloride dose, indications. Reversal of succinylcholine induced apnea with an organophosphate scavenging recombinant butyrylcholinesterase brian c. Issue 1 succinylcholineinduced prolonged apnea in a 3weekold newb. Succinylcholine has serious interactions with at least 28 different drugs. Larrimore, jacquelyn kilbourne, latha kannan, tsafrir s. Apnea in succinylcholinemodified electroshock therapy. The management of succinylcholine apnoea barker 2003. 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. Prolonged succinylcholine apnoea reversed by prostigmin. 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. Based on theoretical considerations, benumof et al. This condition, succinylcholine apnea, is believed to exist in 1 in.
Succinylcholine was repeatedly administered to 60 male patients as an adjuvant to electroshock therapy. Succinylcholine apnea in an unusual case posted for. In the acquired condition the level of plasma cholinesterase is normal but its activity is reduced. Possible decreased plasma cholinesterase activity in patients with severe renal impairment. Volume 74 issue 1 succinylcholineinduced prolonged apnea in a 3weekold newb. Causes and prevention of prolonged apnea with succinylcholin. 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. May, 2019 anectine succinylcholine chloride is an ultra shortacting depolarizingtype, skeletal muscle relaxant for intravenous iv administration. Succinylcholine and pseudocholinesterase jama jama network. Succinylcholine apnea anesthesiology asa publications. I remembered well the teaching i received as a junior that succinylcholine apnoea never killed anybody but attempts to treat it might. Of the 60 patients, 51 had the usual or normal type of serum cholinesterase, as defined by inhibition tests.
Edrophonium 10 mg, given 74 min after succinylcholine, when trainoffour stimulation was characteristic of phase ii block, produced partial antagonism which was not. 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. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Suxamethonium apnoea occurs when a person has a low level of the enzyme cholinesterase also known as butyrylcholinesterase or pseudocholinesterase in the bloodstream.
A variety of pathologic conditions, physiologic alterations, and medications also can lower plasma pseudocholinesterase activity. 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. When succinylcholine is given to a person with this defect, it continues to suppress breathing long after the general anesthesia has worn off. Interactions for succinylcholine chloride specific drugs. Of the 60 patients, 51 had the usual or normal type of serum cholinesterase, as defined by inhibition tests with. Pseudocholinesterase deficiency is an inherited enzyme abnormality that results in abnormally slow metabolic degradation of exogenous choline ester drugs such as succinylcholine. The intermittent use of succinylcholine to keep the patient just apneic is called the in and out of apnea technique and has several advantages. 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. This process leads to paralysis of all skeletal muscles, starting with the small muscles of the face and paralyzing the diaphragm last. This document does not contain all possible interactions. Numerous case reports in literature of prolonged apnea and paralysis after exposure to succinylcholine and organophosphate insecticides.