SummaryNo drugs in anaesthesia are more problematic than suxamethonium. Yet, no drugs have survived as suxamethonium does in spite of crisis after crisis, and attempt after attempt at its replacement. For decades, suxamethonium has taught us neuromuscular pharmacology and provided us with an encyclopaedia of side effects, while benefiting millions and millions of our anaesthetised patients. With the arrival of sugammadex, it finally appears that suxamethonium can be retired. Suxamethonium has done its job and seen its days! The present review is intended to offer a eulogy for suxamethonium.
The author, his institutions of af®liation, and his colleagues have ®nancial interest in a series of novel bistropinium neuromuscular blocking (NMB) agents. Their work on that series of compounds is being sponsored in part by Organon, Inc. and was previously supported in part by Burroughs-Wellcome, Inc.
We studied recovery in 25 adult patients, ASA I, undergoing elective orthopaedic procedures after anaesthesia with 0.65 MAC desflurane (n = 16) or isoflurane (n = 9) with 60% nitrous oxide in oxygen. Early emergence from anaesthesia was assessed in the operating room by measuring time to spontaneous movement, cough, response to painful pinch, tracheal extubation, opening of the eyes and stating correct age, name and body parts. The return of cognitive functions in the late recovery phase was assessed in the post-anaesthesia care unit (PACU) by post-anaesthesia recovery scores (PARS), the Trieger dot test (TDT), and the digit substitution test (DST). In the early recovery phase, time to tracheal extubation, opening eyes, telling correct name, age and body parts occurred significantly faster in the desflurane group than in the isoflurane group (P < 0.05). The mean "triple orientation" time (to name, age, body parts) was 10.9 (SEM 0.9) min for desflurane, compared with 18.6 (2.5) min for isoflurane (P < 0.01). In the late recovery phase, desflurane patients had significantly greater PARS, more correct responses to the DST and fewer error responses to the TDT. Recovery times were not increased by increased duration of desflurane anaesthesia. The desflurane patients showed no delirium, minimal sedation and less shivering during the entire postoperative course. We conclude that desflurane anaesthesia was superior to isoflurane anaesthesia, not only in emergence, but also in the recovery of cognitive functions.
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