Effect of Pretreatment With Magnesium Sulphate on Succinylcholineinduced Fasciculations and Myalgia

Abstract

BACKGROUNDSuccinylcholine, a depolarising muscle relaxant possesses a unique property of rapid onset and short duration of action, but is accompanied by side effects such as fasciculations and myalgia. A prospective randomised-controlled trial was designed to assess the effect of a combination of magnesium sulphate with propofol for induction of anaesthesia on succinylcholine-induced fasciculations and myalgia. MATERIALS AND METHODS60 adult patients of ASA status I and II of both sexes for elective surgery under general anaesthesia were randomly allocated into two equal groups, group MG and group NS. The patients of MG group were pretreated with magnesium sulphate 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 mins. Anaesthesia was administered with pentazocine 0.6 mg/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 hrs. of surgery and graded as nil, mild, moderate or severe. Observations were made in double blind manner where the observer and the patient were blinded. RESULTSDemographic data and baseline parameters of both groups were comparable (P>0.05). Muscle fasciculations occurred in 66.7% patients of MG group versus 100% patients of NS group with a significant difference (P<0.001). After 24 hrs. of surgery, 12 patients of MG group and 28 patients of NS group had myalgia with a significant difference (P<0.001). Statistically significant difference was found in MAP and heart rate at various intervals between the two groups (P<0.001). CONCLUSIONMagnesium sulphate 40 mg/kg intravenously maybe used with propofol for induction of anaesthesia to control succinylcholineinduced fasciculations and myalgia. KEYWORDSPropofol, Magnesium Sulphate, Succinylcholine, Fasciculations and Postoperative Myalgia. HOW TO CITE THIS ARTICLE: Raman A, Singh RK, Sarwer F, et al. Effect of pretreatment with magnesium sulphate on succinylcholine-induced fasciculations and myalgia. BACKGROUNDSuccinylcholine, a depolarising 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 fasciculations, myalgias, masseter spasm, hyperkalaemia, rhabdomyolysis, etc. It also increases intracranial pressure, intraocular pressure and intragastric pressure. 1 The pathophysiology of fasciculations is unclear, but it may be induced by axonal depolarisation caused by connection between succinylcholine and presynaptic and cholinergic nicotinic receptors. 2 Many attempts have been made to avoid these undesirable effects, which include pretreatment with rocuronium, 3 Financial or Other, Compe...

An Investigation Into the Effects of Magnesium Sulfate on the Complications of Succinylcholine Administration in Nulliparous Women Undergoing Elective Cesarean Section: A Double-Blind Clinical Trial

“…In the present study, the preventive administration of magnesium sulfate in group B reduced the severity of fasciculation following the injection of succinylcholine. Further, other studies confirmed the findings of the present study regarding the positive and beneficial effects of the prophylactic administration of magnesium sulfate on fasciculation control (26)(27)(28). It seems that magnesium sulfate prevents severe fasciculation reactions by inhibiting acetylcholine secretion after the injection of succinylcholine.…”