Goodbye Suxamethonium!

Abstract

SummaryNo drugs in anaesthesia are more problematic than suxamethonium. Yet, no drugs have survived as suxamethonium does in spite of crisis after crisis, and attempt after attempt at its replacement. For decades, suxamethonium has taught us neuromuscular pharmacology and provided us with an encyclopaedia of side effects, while benefiting millions and millions of our anaesthetised patients. With the arrival of sugammadex, it finally appears that suxamethonium can be retired. Suxamethonium has done its job and seen its days! The present review is intended to offer a eulogy for suxamethonium.

Our love-hate relationship with succinylcholine: Is sugammadex any better?

“…15 This is exciting news for the anesthesia community, since we now have a drug that can quickly reverse the effect of high-dose rocuronium required for RSI-it potentially allows us to stop using succinylcholine. 16,17 Following the introduction of sugammadex, we recently sought to determine its impact on the clinical use of succinylcholine by informally soliciting information from colleagues in ten countries around the globe (Australia, Germany, Italy, Malaysia, New Zealand, Saudi Arabia, Singapore, Switzerland, United Kingdom, and Venezuela) and focusing solely on the issue of RSI. Four questions were asked: 1) Do you still employ RSI?…”

“…14 15 Ces nouvelles sont réjouissantes pour la communauté de l'anesthésie, étant donné que nous disposons désormais d'un médicament qui peut rapidement neutraliser l'effet des fortes doses de rocuronium nécessaires à l'ISR -et il nous permettra peut-être d'arrêter d'utiliser la succinylcholine. 16,17 Suite à l'introduction du sugammadex, nous avons récemment tenté de déterminer son impact sur l'utilisation clinique de la succinylcholine en demandant de l'information, de façon informelle, à nos collègues de dix pays dans le monde entier (Australie, Allemagne, Italie, Malaisie, Nouvelle-Zélande, Arabie saoudite, Singapour, Suisse, Royaume-Uni et Venezuela) et en nous concentrant exclusivement sur la question de l'ISR. Nous leur avons posé quatre questions : 1) Employez-vous toujours l'ISR?…”

Site marking for peripheral nerve blockade to reduce the incidence of incorrect side regional anaesthesia

“…Incorrect site surgery has been defined as a 'never event' by the National Patient Safety Agency [1]. In regional anaesthesia, performing a nerve block on the incorrect side is a rare event, but a very serious error.…”

“…Correspondence presented in any other style or format will be returned to the author for revision. Anaesthesia, 2009, 64, pages 1022-1036 ................................................................................................................................................................................................................ We read Lee's article with great interest [1], in which the author suggests that in present day practice suxamethonium finds its utility in only a handful of situations. Under the subheading 'a new challenge to suxamethonium', the author further explains that with the availability of rocuronium and sugammadex, even in these situations there is no real role left for suxamethonium and concludes that suxamethonium has done its job!…”

How low can you go? Lowest effective dose of neuromuscular blocking agent for tracheal intubation

“…1 Rocuronium 1.2 mg Á kg -1 , followed by sugammadex in appropriate dosage, can also be made to mimic the onset-offset profile of succinylcholine. 2 Thus, the end of the ''Era of Succinylcholine'' is being announced at regular intervals, most recently by Lee,3 who this year opined, ''…it finally appears that suxamethonium can be retired. Suxamethonium has done its job and has seen its day!''…”