Comparison between succinylcholine and rocuronium as neuromuscular blocking agents for electroconvulsive therapy in a patient with pseudocholinesterase deficiency

Abstract

We report here the anesthetic management of a patient with schizophrenia and pseudocholinesterase deficiency. Electroconvulsive therapy was performed using succinylcholine and rocuronium as the neuromuscular blocking agents in the first seven and latter six treatments, respectively. The recovery time from muscle relaxation after succinylcholine administration was remarkably longer than that after rocuronium-sugammadex administration. Rocuronium and sugammadex appear to be useful in situations in which succinylcholine is contraindicated.

Does the Use of Rocuronium-Sugammadex Instead of Succinylcholine in Electroconvulsive Therapy Affect Seizure Duration?

“…10,18 Even at low doses, the combination of rocuronium-sugammadex seems to be an ideal alternative in ECT anesthesia when seizure duration, the incidence of side effects, and hemodynamic parameters are taken into account, especially in cases where succinylcholine is contraindicated. 17 Hemodynamic parameters were similar in both groups. The postoperative period was generally uneventful in both groups, and the patients were discharged from the post-anesthesia care unit approximately 60 minutes later.…”

“…35 On the other hand, Kadoi et al 14 compared rocuronium with 0.6 mg kg -1 and different doses of sugammadex and 1 mg kg -1 of succinylcholine in propofol anesthesia and found no significant difference in seizure duration among all groups. Takazawa et al 17 reported succinylcholine below the normal application dose (0.24±0.23 mg kg -1 ) in the first seven ECT sessions in a schizophrenic patient with pseudocholinesterase deficiency, rocuronium (0.52±0.02 mg kg -1 ) in the next six ECT sessions, and to reverse the block, 200-400 mg sugammadex was used and they reported that seizure duration was not different between succinylcholine and rocuronium-sugammadex. They interpreted that improvement in a depressive state with ECT may affect seizure duration, therefore, the use of rocuronium after succinylcholine may mask ECT seizure duration, which is likely to be longer with rocuronium administration.…”

“…There are several reports evaluating the effects of rocuronium versus succinylcholine on seizure variables of ECT. 11,[13][14][15][16][17]31 In their cross-over study, Turkkal et al 31 reported that motor seizure duration was greater after 0.3 mg kg -1 rocuronium compared with 1 mg kg -1 succinylcholine (33 and 24 s, respectively) and suitable for ECT. They stated that this difference may be due to the electrical stimulation given after the cessation of fasciculations in the succinylcholine group, and the electrical stimulation 90 s after the muscle relaxant administration in the rocuronium group.…”

“…In a case report, Postaci et al 11 reported no agitation during neuromuscular recovery in a patient switched to a combination of 0.4 mg kg -1 rocuronium and 2 mg kg -1 sugammadex instead of 0.5 mg kg -1 succinylcholine after severe agitations during the recovery period of all his five consecutive ECT sessions. In a patient with pseudocholinesterase deficiency and treated with low dose succinylcholine (0.24±0.23 mg kg -1 ) for the first seven ECT sessions, and with rocuronium (0.52±0.02 mg kg -1 ) and 200-400 mg sugammadex for other eight sessions, Takazawa et al 17 reported that the recovery time from muscle relaxation after succinylcholine administration was remarkably longer than that after rocuronium-sugammadex administration.…”

Análisis costo-efectividad de rocuronio y succinilcolina en tiroidectomías programadas

“…En la búsqueda de la alternativa a succinilcolina como relajante neuromuscular en tiroidectomías, se tuvo en cuenta un medicamento que proveyera condiciones seguras y adecuadas, rápida recuperación de la función psicomotora y pocas reacciones adversas; en estos aspectos, rocuronio es el que mejor se perfila [4]. Por tales motivos, el presente estudio tiene por objetivo realizar un análisis farmacoeconómico de tipo costo-efectividad en el que se compararon los períodos de latencia, condiciones de intubación, costos asociados a las variables mencionadas, tiempos de recuperación y reacciones adversas causadas por estos agentes, proporcionando evidencias que permitan un análisis completo al momento de elegir los relajantes neuromusculares que se van a utilizar en tiroidectomías.…”