Comparative Study on the Effects of Pretreatment With Magnesium Sulphate and Propofol Induction on Serum Creatine Phosphokinase and Urinary Myoglobin Levels Associated With the Use of Succinylcholine

Abstract

Succinyl Choline possess unique properties of rapid onset and short duration of action to facilitate endo tracheal intubation but myalgias, hyperkalemia, increase in serum myoglobin, creatine phosphokinase and masseter spasm are adverse effects associated with its use in apparently healthy population. The aim of present study is to compare the effects of with and without pretreatment with magnesium sulphate and propofol induction on serum creatine phosphokinase and urinary myoglobin levels associated with use of succinyl choline. 60 patients aged between 18-60 years of both sexes of ASA Grade-I and II undergoing elective Surgery with minimal or no muscle damage were divided into two groups randomly. After taking informed consent, patient was shifting to operation table, monitors were connected, vital parameters recorded, intravenous line secured and 2ml of blood was collected in plain bottle and 10-15ml of urine sample was collected and set to lab for serum creatine phosphokinase and urinary myoglobin estimation. Patients of both groups were preoxygenated for 5 minutes, premedicated with Inj. Gycopyrolate (0.2mg) iv, Inj. Fentanyl 2 Micro Grams per Kg iv and induced with Inj. Propofol 2mg/kg and succinyl choline 2mg./kg was given to facilitate endotracheal intubation. One group was pretreated with 10cc of 0.9% Normal saline and other group with magnesium sulphate 40mg/kg in 10ml slowly over 10 minutes before induction with propofol. The occurrence of fassiculations was noted. 10-15ml of urine was collected in both groups for myoglobin estimation 20 minutes after intubation. At the end of surgery patients was revered with neostigmine (0.07mg/kg) and Inj. Glycopyrdate (0.01mg/kg). After complete recovery extubation was done and patient shifted to postoperative ward 2ml of blood was collected 20-24 hours post-surgery for serum creatine phosphokinare estimations and results tabulated. The study found that there was raise in serum phosphokinase levels in both groups. The raise was significantly lower in magnesium sulphate group compared to other group, urinary myoglobin was detected in both groups but significantly lower in magnesium sulphate group. Fasiculations and postoperative myalgias were significantly lower in magnesium sulphate group. In conclusion magnesium sulphate is effective in lowering serum creatine phosphokinase levels, urinary myoglobin levels, postoperative myalgias and fasiculations associated with use of succinyl choline.

The Antioxidant Effect of Selenium on Succinylcholine-related Myalgia After Adult Sinuscopies: Randomized Controlled Double-Blind Trial

“…Abraham, and his colleagues (18), did not find any statistically significant changes in the levels of K+ and CK when using rocuronium prior to the injection of succinylcholine. Another research detected the CK levels after using succinylcholine and reported that the average postoperative increase in the study groups was statistically significant (23). Other investigators notified a significant increase in K+ and CK levels following succinylcholine administration (9).…”

Fasciculations and Hyperkalaemia Associated with Suxamethonium: Efficacy of Magnesium Sulphate

“…It possesses a unique property of rapid onset and short duration of action, but is accompanied by side effects like muscular fasciculation, myalgia, masseter muscle spasm, hyperkalemia, rhabdomyolysis, increase intracranial pressure, intraocular pressure and intragastric pressure. [1] The succinylcholine induced postoperative myalgia (POM) has been shown to occur in 41% -92% of patient. [2] The pathophysiology of fasciculation and myalgia is unclear and exact mechanism of succinylcholine induced myalgia is still unknown.…”

Prevention of Succinylcholine Induced Postoperative Myalgia by Pretreatment with Lignocaine: A Randomized Controlled Study

“…Succinylcholine, a depolarizing muscle relaxant was introduced in 1952 by Sleff and Foldes and has a unique place in clinical practice, because it causes quick and excellent skeletal muscle relaxation for few minutes followed by spontaneous recovery. It possesses a unique property of rapid onset and short duration of action, but is accompanied by side effects like muscular fasciculation, myalgia, masseter muscle spasm, hyperkalemia, rhabdomyolysis, increase intracranial pressure, intraocular pressure and intragastric pressure 1 . This succinylcholine induced postoperative myalgia (POM) has been shown to occur in 41%-92% of patients 2 .…”