Differential Effects of Neuromuscular Blocking Agents on Suxamethonium-Induced Fasciculations and Myalgia

Sullivan, E.P. O'; Williams, N. E.; Calvey, T. N.

doi:10.1093/bja/60.4.367

Cited by 34 publications

(12 citation statements)

References 18 publications

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“…Only mild myalgia occurred in both group, 10% in the saline group, and 5% in the remifentanil group. Thus, the results of the present study correspond with studies reporting that there is no direct correlation between intensity of fasciculation and frequency of myalgia, and it is more likely that the etiology of myalgia is multifactorial 6,14-16. The results also correspond with the study reporting that the use of opioid during induction is not related with postoperative myalgia 5…”

Section: Discussionsupporting

confidence: 89%

Remifentanil Attenuates Muscle Fasciculations by Succinylcholine

Yun

Kim

et al. 2010

Yonsei Med J

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PurposeThe present visual and electromyographic study was designed to evaluate muscle fasciculations caused by succinylcholine in adults pretreated with either remifentanil 1.5 µg/kg or saline.Materials and MethodsThe effect of remifentanil on succinylcholine-induced muscle fasciculations was studied using a double-blind method in 40 adults. After i.v. pretreatment with either remifentanil 1.5 µg/kg (remifentanil group, n = 20) or an equivalent volume of i.v. saline (saline group, n = 20), patients were anaesthetized with a 2.0 mg/kg of i.v. propofol followed by i.v. succinylcholine 1.0 mg/kg. Intensity and duration of muscle fasciculation following i.v. succinylcholine administration were recorded. Electromyography (EMG) was used to quantify the extent of muscle fasciculation following i.v. succinylcholine injection. Myalgia was evaluated 24 hours after induction time. Serum potassium levels were measured five minutes after i.v. succinylcholine administration and creatine kinase (CK) levels 24 hours after induction time.ResultsCompared to saline treated controls, remifentanil decreased the intensity of muscle fasciculations caused by i.v. succinylcholine [fasciculation severity scores (grade 0 to 3) were 2/1/12/5 and 3/13/4/0 (patients numbers) in the saline group and the remifentanil group, respectively, p < 0.001]. The mean (SD) maximum amplitude of muscle action potential (MAP) by EMG was smaller in the remifentanil group [283.0 (74.4) µV] than in the saline group [1480.4 (161.3) µV] (p = 0.003). Postoperative serum CK levels were lower in the remifentanil group (p < 0.001). Postoperative myalgia was not different between the two groups.ConclusionRemifentanil 1.5 µg/kg attenuated intensity of muscle fasciculations by succinylcholine.

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Section: Discussionsupporting

confidence: 89%

Remifentanil Attenuates Muscle Fasciculations by Succinylcholine

Yun

Kim

et al. 2010

Yonsei Med J

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“…[1718] Literature, however, shows no correlation between fasciculations and postoperative myalgia. [1920] Laurence[17] observed no correlation between myalgia and rise in creatine kinase, an indicator of muscle damage. Collier observed a transient fall in serum calcium levels at 1 min, following succinylcholine administration in patients who had postoperative myalgia and postulated that influx of calcium in to muscle cells caused an increase in muscle damage and pains.…”

Section: Discussionmentioning

confidence: 99%

Effect of magnesium sulfate with propofol induction of anesthesia on succinylcholine-induced fasciculations and myalgia

Kumar

Talwar

Goyal

et al. 2012

J Anaesthesiol Clin Pharmacol

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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.

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“…An extensive literature on this subject has been developed, including studies of all the available nondepolarising neuromuscular blockers in a variety of doses (Table 1). These include gallamine, d‐tubocurarine, vecuronium, pancuronium, atracurium and rocuronium [29, 35, 36, 38, 52, 74, 92, 95]. In these studies, different doses and pretreatment administration times were studied.…”

Section: Methods Used To Reduce Myalgiamentioning

confidence: 99%

Succinylcholine‐associated postoperative myalgia

Wong

Chung

2000

Anaesthesia

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SummaryThe subject of postoperative myalgia associated with the use of succinylcholine is reviewed. We discuss the mechanisms of succinylcholine-induced myalgia and the techniques available to prevent and treat the myalgia. In situations where patients are at risk of developing myalgia and succinylcholine is the neuromuscular blocker of choice, the use of a combination of techniques may prove to be a useful strategy.

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Differential Effects of Neuromuscular Blocking Agents on Suxamethonium-Induced Fasciculations and Myalgia

Cited by 34 publications

References 18 publications

Remifentanil Attenuates Muscle Fasciculations by Succinylcholine

Remifentanil Attenuates Muscle Fasciculations by Succinylcholine

Effect of magnesium sulfate with propofol induction of anesthesia on succinylcholine-induced fasciculations and myalgia

Succinylcholine‐associated postoperative myalgia

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