Failure of Nondepolarizing Neuromuscular Blockers to Inhibit Succinylcholine-induced Increased Intraocular Pressure, A Controlled Study

Meyers, Elsie F.; Krupin, Theodore; Johnson, Mark I.; Zink, Harry A.

doi:10.1097/00000542-197802000-00013

Cited by 60 publications

(11 citation statements)

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“…reported that IOP rise that accompanies succinylcholine injection was not related to the existence or absence of muscle fasciculation. [ 29 ] They attributed the succinylcholine-induced rise of IOP to its slow tonic effect on extraocular muscles dissimilar to its effects on skeletal muscles and vasodilatation of choroidal vessels. Their data demonstrated that the pretreatment with nondepolarizing neuromuscular blockers was not efficient in preventing the succinylcholine-induced rise of IOP contrary to the findings of Miller et al .…”

Section: Discussionmentioning

confidence: 99%

The influence of two different doses of magnesium sulfate on intraocular pressure variations after injection of succinylcholine and endotracheal intubation: A prospective, randomized, parallel three-arm, double-blind, placebo-controlled clinical trial

et al. 2017

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Background:The use of succinylcholine for rapid sequence induction in patients with open globe injuries may be detrimental to the eye.Aim:The aim of this study is to determine if the premedication with magnesium sulfate (MgSO4) could attenuate the increase in intraocular pressure (IOP) associated with succinylcholine injection and intubation.Setting:Operation theaters in a tertiary care University Hospital between December 2014 and July 215.Design:This was a prospective, randomized, parallel three-arm, double-blind, placebo-controlled clinical trial.Participants:One hundred and thirteen patients’ physical status ASA Classes I and II underwent elective cataract surgery under general anesthesia.Patients and Methods:These patients allocated into three groups: Group C (control group) received 100 ml normal saline, Group M1 received 30 mg/kg MgSO4 in 100 ml normal saline, and Group M2 received 50 mg/kg MgSO4 in 100 ml normal saline. IOP, mean arterial pressure (MAP), and heart rate (HR) reported at 5-time points related to study drug administration. In addition, any adverse effects related to MgSO4 were recorded. Intragroup and between-groups differences were examined by analysis of variance test.Results:We noticed a significant decrease in IOP in M1 (n = 38) and M2 (n = 37) groups as compared with C group (n = 38) after study drugs infusion, 2 and 5 min after intubation, P < 0.001. While the difference between M1 and M2 groups was insignificant, P = 0.296 and P = 0.647, respectively. There was a significant decrease in MAP and HR in M1 and M2 groups as compared with C group 2 and 5 min after intubation, P = 0.01. While the difference between M1 and M2 groups was insignificant, P = 1.Conclusion:MgSO4 30 mg/kg as well as 50 mg/kg effectively prevented the rise in IOP, MAP, and HR associated with rapid sequence induction by succinylcholine and endotracheal intubation.

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Section: Discussionmentioning

confidence: 99%

The influence of two different doses of magnesium sulfate on intraocular pressure variations after injection of succinylcholine and endotracheal intubation: A prospective, randomized, parallel three-arm, double-blind, placebo-controlled clinical trial

et al. 2017

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“…Following suxamethonium, both eyes showed equal increases in lOP, thus refuting the long-held belief that the sustained contraction of the extraocular muscles mechanically caused the rise in lOP (Kelly et al 1993). However, more recent studies have refuted this in both adults and children (Cook 1981;Meyers et al 1978). However, more recent studies have refuted this in both adults and children (Cook 1981;Meyers et al 1978).…”

Section: Increased Intraocular Pressurementioning

confidence: 89%

Adverse Effects of Depolarising Neuromuscular Blocking Agents

1994

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Muscle relaxants block neuromuscular transmission, acting at nicotinic acetylcholine receptors of the neuromuscular junction. Suxamethonium (succinylcholine) is a depolarising agent, whereas all other relaxants in clinical use are nondepolarising. The desired neuromuscular block results from the structural similarity of muscle relaxants to acetylcholine, enabling the interaction with receptors at the neuromuscular junction. Adverse effects of suxamethonium are generally related to its agonist mode of action. Autonomic cardiovascular effects may result. Other adverse effects include anaphylactic or anaphylactoid reactions, and histamine release. Various disease states may present specific considerations in the use of muscle relaxants. Although many complications of muscle relaxants (such as prolonged block or resistance) are easily treated, others may require immediate intervention and vigorous therapy. Careful selection of appropriate relaxants for particular patients will usually prevent the occurrence of complications.

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“…10 Although pretreatment with a non-depolarizing neuromuscular blocker such as 3 mg of curare or vecuronium 1 mg has been advocated, this does not reliably prevent the increase. 11 The risk of extrusion of intraocular contents in a patient with an open eye injury given suxamethonium is rare; however, we chose to perform a rapid sequence induction using rocuronium as the neuromuscular blocking agent.…”

Section: Discussionmentioning

confidence: 99%

Use of rocuronium in a pregnant patient with an open eye injury, receiving magnesium medication, for preterm labour

Gaiser

Seem

1996

British Journal of Anaesthesia

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We present a case where rocuronium 80 mg (3 x ED95) was used in a rapid sequence induction in a 80-kg pregnant patient with an open eye injury. The patient was also receiving magnesium 2 g h-1 i.v. for preterm labour. The expected duration for neuromuscular block of rocuronium in the absence of magnesium would be approximately 53 min; with infusion of magnesium, the duration of neuromuscular block was prolonged four-fold (215 min). It is important to remember that magnesium potentiates the effects of all non-depolarizing neuromuscular blocking agents, including rocuronium.

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Failure of Nondepolarizing Neuromuscular Blockers to Inhibit Succinylcholine-induced Increased Intraocular Pressure, A Controlled Study

Cited by 60 publications

References 0 publications

The influence of two different doses of magnesium sulfate on intraocular pressure variations after injection of succinylcholine and endotracheal intubation: A prospective, randomized, parallel three-arm, double-blind, placebo-controlled clinical trial

The influence of two different doses of magnesium sulfate on intraocular pressure variations after injection of succinylcholine and endotracheal intubation: A prospective, randomized, parallel three-arm, double-blind, placebo-controlled clinical trial

Adverse Effects of Depolarising Neuromuscular Blocking Agents

Use of rocuronium in a pregnant patient with an open eye injury, receiving magnesium medication, for preterm labour

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