Optimal dose of succinylcholine for tracheal intubation in patients during inhalation induction with sevoflurane: a randomized controlled trial

Luo, Li; Huang, Wei; Zhou, Liangxue; Wang, Jian; Xu, Li; Li, Ping

doi:10.1016/j.jclinane.2014.03.014

Cited by 5 publications

(10 citation statements)

References 22 publications

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“…One trial was not blinded and therefore judged to be at high risk of bias ( Figure S1 and S2) [23]. Two trials reported sources of authors' funding and conflicts of interest [24,26].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All five used intravenous propofol 2 mg kg − 1 with a concomitant intravenous opioid for induction. The sixth study used an induction technique with sevoflurane without intravenous opioids; there was no delay between loss of consciousness and the administration of succinylcholine [26]. One study specified the use of a cricoid pressure [24].…”

Section: Induction Techniquesmentioning

confidence: 99%

“…With the standard succinylcholine regimen (1.0 mg kg − 1 ), the incidence of excellent intubating conditions ranged from 58% [26] to 100% [24,25] (cumulative number of patients, 185 of 233 [79%]) (Fig. 2).…”

Section: Quality Of Intubating Conditions Excellent Intubating Conditmentioning

confidence: 99%

“…With four experimental regimens that were tested in at least three trials each (0.3, 0.4, and 0.5 mg kg − 1 ) [21][22][23][24][25][26], excellent intubating conditions were significantly less frequent compared with 1.0 mg kg − 1 (ARD ranging from − 9% to − 67%) (Fig. 2).…”

Section: Quality Of Intubating Conditions Excellent Intubating Conditmentioning

confidence: 99%

“…With the standard succinylcholine regimen (1.0 mg kg − 1 ), average apnoea times, reported in four trials [22,[24][25][26], ranged from 4.0 min [26] to 8.2 min [24] ( Fig. 4).…”

Section: Apnoea Timesmentioning

confidence: 99%

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The optimal dose of succinylcholine for rapid sequence induction: a systematic review and meta-analysis of randomized trials

et al. 2020

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Background: The evidence base for the widely accepted standard regimen of succinylcholine for rapid sequence induction (1.0 mg kg − 1) remains unclear. Methods: We performed a systematic review and meta-analysis of randomized trials comparing any succinylcholine regimen with the standard regimen (1.0 mg kg − 1) and reporting on intubating conditions and/or apnoea times. Results were expressed as absolute risk differences (ARD) for dichotomous data and mean differences (MD) for continuous data. Results: We retrieved six trials with relevant data of 864 patients (ASA 1 or 2, aged 18-65 years, body mass index < 30 kg m − 2). Four regimens (0.3, 0.4, 0.5, 0.6 mg kg − 1) were compared with 1.0 mg kg − 1 in at least three trials each, and three (0.8, 1.5, 2 mg kg − 1) in one each. With 0.3 to 0.5 mg kg − 1 , the likelihood of excellent intubating conditions was significantly decreased (ARD − 22% to − 67%). With 0.3 and 0.4 mg kg − 1 , but not with 0.5, 0.6, 0.8, 1.5 and 2.0 mg kg − 1 , the likelihood of unacceptable intubating conditions was significantly increased (ARD + 22% and + 32%, respectively). With 2.0 mg kg − 1 , but not with 0.8 or 1.5 mg kg − 1 , the likelihood of excellent intubating conditions was significantly increased (ARD + 23%). Apnoea times were significantly shorter with regimens ≤0.8 mg kg − 1 (MD − 1.0 to − 3.4 min) but were not reported with 1.5 or 2.0 mg kg − 1. Conclusions: With succinylcholine regimens ≤0.5 mg kg − 1 , excellent intubating conditions are less likely and apnoea times are shorter, compared with 1 mg kg − 1. With 0.3 and 0.4 mg kg − 1 , unacceptable intubating conditions are more common. Succinylcholine 1.5 mg kg − 1 does not produce more often excellent conditions compared with 1 mg kg − 1 , while 2.0 mg kg − 1 does, but the database with these regimens is weak and apnoea times remain unknown. Limited information size and strong statistical heterogeneity decrease the certainty of the evidence.

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“…One trial was not blinded and therefore judged to be at high risk of bias ( Figure S1 and S2) [23]. Two trials reported sources of authors' funding and conflicts of interest [24,26].…”

Section: Study Characteristicsmentioning

confidence: 99%

Section: Induction Techniquesmentioning

confidence: 99%

Section: Quality Of Intubating Conditions Excellent Intubating Conditmentioning

confidence: 99%

Section: Quality Of Intubating Conditions Excellent Intubating Conditmentioning

confidence: 99%

“…With the standard succinylcholine regimen (1.0 mg kg − 1 ), average apnoea times, reported in four trials [22,[24][25][26], ranged from 4.0 min [26] to 8.2 min [24] ( Fig. 4).…”

Section: Apnoea Timesmentioning

confidence: 99%

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The optimal dose of succinylcholine for rapid sequence induction: a systematic review and meta-analysis of randomized trials

et al. 2020

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Monitoring Depth of Neuromuscular Blockade and Adequacy of Reversal: Clinical and Pharmacoeconomic Implications

Wachtendorf,

Ahrens,

Suleiman

et al. 2023

Curr Anesthesiol Rep

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Succinylcholine and postoperative pulmonary complications: a retrospective cohort study using registry data from two hospital networks

Schaefer

Hammer

Santer

et al. 2020

British Journal of Anaesthesia

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Background: Neuromuscular blocking agents (NMBAs) with a non-depolarising mechanism of action carry the risk of postoperative residual paralysis and are associated with postoperative pulmonary complications (POPC). Owing to the shorter duration of action, the depolarising NMBA succinylcholine may be associated with less postoperative residual paralysis, and hence fewer POPC. We tested the association of succinylcholine administration during anaesthesia and POPC. Methods: In a retrospective cohort study of registry data from two large US academic medical centres, 244 850 adult noncardiac surgical patients undergoing general anaesthesia were included. The primary outcome was POPC, defined as post-extubation haemoglobin oxygen de-saturation to <90%, or re-intubation requiring intensive care unit admission within 7 days after surgery. The association between succinylcholine and POPC and its dose-dependency were tested in a hierarchical fashion using a multivariable logistic regression model. Results: A total of 13 206 patients (5.4%) experienced POPC. Use of succinylcholine was associated with increased risk of POPC (adjusted odds ratio [OR Adj ]¼1.11; 95% confidence interval [CI], 1.06e1.16; P<0.001; adjusted risk¼5.18%; 95% CI, 5.06e5.30 without and 5.69%; 95% CI, 5.53e5.85 with succinylcholine), with a dose-dependent relationship (OR Adj ¼1.08; 95% CI, 1.05e1.11 per mg kg À1 ; P<0.001). In patients receiving non-depolarising NMBAs, succinylcholine further increased the risk of POPC (ORAdj¼1.08; 95% CI, 1.03e1.14; P¼0.001). The association between succinylcholine and POPC was modified (P¼0.03 for interaction) by the duration of surgery with higher odds of POPC in patients undergoing surgeries of <2 vs !2 h (OR Adj ¼1.24; 95% CI, 1.15e1.33 and 1.05; 95% CI, 1.00e1.10, respectively). Conclusions: In contrast to our prediction, succinylcholine administration was associated with an increased risk of POPC. This association was dose-dependent and magnified in surgeries of shorter duration.

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Optimal dose of succinylcholine for tracheal intubation in patients during inhalation induction with sevoflurane: a randomized controlled trial

Cited by 5 publications

References 22 publications

The optimal dose of succinylcholine for rapid sequence induction: a systematic review and meta-analysis of randomized trials

The optimal dose of succinylcholine for rapid sequence induction: a systematic review and meta-analysis of randomized trials

Monitoring Depth of Neuromuscular Blockade and Adequacy of Reversal: Clinical and Pharmacoeconomic Implications

Succinylcholine and postoperative pulmonary complications: a retrospective cohort study using registry data from two hospital networks

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