Succinylcholine, paraplegia, and intraoperative cardiac arrest. A case report.

Nash, Clyde L.; Haller, Reinhard; Brown, R. H.

doi:10.2106/00004623-198163060-00020

Cited by 7 publications

(4 citation statements)

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“…In fact, hyperkalemia-related cardiac arrest has been reported following its administration. 20,[32][33][34][35][36][37][38][39][40][41][42][43][44][45] A common challenge facing EPs is to identify those patients who may be hyperkalemic prior to intubation. A history of renal failure and the presence of an atrioventricular shunt are obvious clues.…”

Section: Discussionmentioning

confidence: 99%

“…Other clinical conditions have also been reported to predispose certain patients to hyperkalemia-related cardiac dysrhythmias, even if their initial serum potassium is within normal limits. These conditions include paraplegia and denervation syndromes, [32][33][34][35]41,45 extensive nonacute burns, 36,46 muscular dystrophy, [37][38][39][40] severe infections, 20,42 severe acidosis, 43 hypokalemia, 44 and chronic digitalis use. 47 These patients can experience an exaggerated hyperkalemic response to succinylcholine, with levels sometimes rising as much as 5.7 mmol/L 20 to a total of 13.6 mmol/L.…”

Section: Discussionmentioning

confidence: 99%

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A Comparison of Succinylcholine and Rocuronium for Rapid‐sequence Intubation of Emergency Department Patients

Laurin

Sakles

Panacek

et al. 2000

Academic Emergency Medicine

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Abstract. Objective: To compare rocuronium and succinylcholine for rapid-sequence intubation (RSI) in the emergency department (ED). Methods: A oneyear prospective cohort comparison study was performed using a data collection form completed at the time of intubation. Data collected included the reason for the neuromuscular-blocking agent (NMBA) chosen, the time to onset of paralysis, and any complications encountered. Three ten-point numerical descriptor scales recorded the degree of body movement, vocal cord movement, and the physician's overall satisfaction with the extent of paralysis. Results: Succinylcholine was used in 382 patients and rocuronium was used in 138 (26% of all RSI) patients. The mean (Ϯ SD) times of onset of succinylcholine and rocuronium were 39 Ϯ 13 sec and 44 Ϯ 20 sec, respectively (p = 0.04). No patient desaturated and required assisted ventilations while waiting for paralysis to occur. Types of body movements were similar with the two agents, but less frequent with succinylcholine (median = 10, mean = 9.5 Ϯ 1.1) than rocuronium (median = 10, mean = 9.1 Ϯ 1.5) (p = 0.01). Vocal cord movements were similar for succinylcholine (median = 10, mean = 9.2 Ϯ 1.6) and rocuronium (median = 9, mean = 9.0 Ϯ 1.6) (p = 0.15). The physician's overall satisfaction with the extent of paralysis was also higher for succinylcholine (median = 10, mean = 9.4 Ϯ 1.3) than rocuronium (median = 10, mean = 8.8 Ϯ 2.0) (p < 0.01). Only one complication, widening of the QRS complex secondary to succinylcholine use in a patient with unsuspected hyperkalemia, could be attributed to the choice of NMBA. Conclusions: Both succinylcholine and rocuronium produced fast and reliable paralysis for RSI. Although succinylcholine had a faster onset and provided more relaxation, the difference had no clinical significance. Approximately a fourth of ED RSI patients qualified for use of rocuronium using these high-risk criteria. Key words: rapid-sequence intubation; tracheal intubation; neuromuscular-blocking agents; succinylcholine; rocuronium. ACADEMIC EMERGENCY MEDICINE 2000; 7:1362-1369 R APID-sequence intubation (RSI) is a lifesaving procedure developed to quickly and safely secure the airway of a critically ill or injured patient. In the emergency department (ED), RSI is often chosen over other intubation techniques because the simultaneous onset of deep sedation and paralysis, followed rapidly by tracheal intubation, minimizes the risk of pulmonary aspiration of gastric contents. Rapid-sequence intubation has therefore become the technique of choice for the intubation of patients at risk of having full stomachs, such as ED patients. Indeed, several recent studies have shown RSI as the most common method to achieve airway control in the ED.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Comparison of Succinylcholine and Rocuronium for Rapid‐sequence Intubation of Emergency Department Patients

Laurin

Sakles

Panacek

et al. 2000

Academic Emergency Medicine

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“…In fact, a rapid and time-dependent increase in plasma potassium concentration is evident in tetraplegic patients during electrically stimulated leg cycling (ESLC) (43). Moreover, severe, life-threatening hyperkalemia can be triggered in SCI individuals by the depolarizing neuromuscular blocking agent succinylcholine (23,49,63). Although this is probably due mainly to accentuated potassium release (39), reduced Na ϩ -K ϩ -ATPase expression could plausibly worsen the situation, especially since skeletal muscle normally possesses the largest pool of Na ϩ -K ϩ -ATPase in the body (9).…”

Section: E867mentioning

confidence: 99%

Influence of chronic and acute spinal cord injury on skeletal muscle Na⁺-K⁺-ATPase and phospholemman expression in humans

Boon

Kostovski

Pirkmajer

et al. 2012

American Journal of Physiology-Endocrinology and Metabolism

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Boon H, Kostovski E, Pirkmajer S, Song M, Lubarski I, Iversen PO, Hjeltnes N, Widegren U, Chibalin AV. Influence of chronic and acute spinal cord injury on skeletal muscle Na ϩ -K ϩ -ATPase and phospholemman expression in humans. Am J Physiol Endocrinol Metab 302: E864 -E871, 2012. First published January 24, 2012; doi:10.1152/ajpendo.00625.2011.-Na ϩ -K ϩ -ATPase is an integral membrane protein crucial for the maintenance of ion homeostasis and skeletal muscle contractibility. Skeletal muscle Na ϩ -K ϩ -ATPase content displays remarkable plasticity in response to long-term increase in physiological demand, such as exercise training. However, the adaptations in Na ϩ -K ϩ -ATPase function in response to a suddenly decreased and/or habitually low level of physical activity, especially after a spinal cord injury (SCI), are incompletely known. We tested the hypothesis that skeletal muscle content of Na ϩ -K ϩ -ATPase and the associated regulatory proteins from the FXYD family is altered in SCI patients in a manner dependent on the severity of the spinal cord lesion and postinjury level of physical activity. Three different groups were studied: 1) six subjects with chronic complete cervical SCI, 2) seven subjects with acute, complete cervical SCI, and 3) six subjects with acute, incomplete cervical SCI. The individuals in groups 2 and 3 were studied at months 1, 3, and 12 postinjury, whereas individuals with chronic SCI were compared with an ablebodied control group. Chronic complete SCI was associated with a marked decrease in [ 3 H]ouabain binding site concentration in skeletal muscle as well as reduced protein content of the ␣ 1-, ␣2-, and ␤ 1-subunit of the Na ϩ -K ϩ -ATPase. In line with this finding, expression of the Na ϩ -K ϩ -ATPase ␣1-and ␣2-subunits progressively decreased during the first year after complete but not after incomplete SCI. The expression of the regulatory protein phospholemman (PLM or FXYD1) was attenuated after complete, but not incomplete, cervical SCI. In contrast, FXYD5 was substantially upregulated in patients with complete SCI. In conclusion, the severity of the spinal cord lesion and the level of postinjury physical activity in patients with SCI are important factors controlling the expression of Na ϩ -K ϩ -ATPase and its regulatory proteins PLM and FXYD5. FXYD proteins; sodium pump; physical inactivity; paralysis THE Na ϩ -K ϩ -ATPase IS AN INTEGRAL MEMBRANE PROTEIN that is crucial for the maintenance of ion homeostasis, cell volume, and muscle contractibility. It is composed of two polypeptide subunits, a catalytic 112-kDa ␣-subunit (␣ 1 -, ␣ 2 -, and ␣ 3 -isoforms) and a 35-to 60-kDa glycosylated ␤-subunit (␤ 1 -, ␤ 2 -, and ␤ 3 -isoforms) (6, 35). The relative abundance of each isoform and Na ϩ -K ϩ -ATPase activity is regulated in a muscleand fiber type-specific manner (29,59,62

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“…Use of the drug between these two points carries an unspecified risk but could possibly be justified in the face of a strong indication. It is worthy of note that in the case reports of cardiac arrest reviewed, all the patients were successfully resuscitated and recovered uneventfully [[54] (two cases), [38] (four cases) [55] (two cases), [56] (one case), [57] (one case), [58] (one case), [59] (two cases), [60] (one case), [61] (three cases)]. It would therefore be unfortunate to allow any spinal patient to die of airway obstruction for fear of causing a hyperkalaemic arrest.…”

Section: Anaesthesiamentioning

confidence: 99%

Anaesthesia for chronic spinal cord lesions

1998

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SummaryIncreasing numbers of patients with spinal cord injury present for surgery or obstetric care. Spinal cord injury causes unique pathophysiological changes. The most important peri-operative dangers are autonomic dysreflexia, bradycardia, hypotension, respiratory inadequacy and muscle spasms. Autonomic dysreflexia is suggested by headache, sweating, bradycardia and severe hypertension and may be precipitated by surgery, especially bladder distension. Patients with low, complete lesions, undergoing surgery below the level of injury, may safely do so without anaesthesia provided there is no history of autonomic dysreflexia or troublesome spasms. An anaesthetist should be present to monitor the patient in this situation. General anaesthesia of sufficient depth is effective at controlling spasms and autonomic dysreflexia but hypotension and respiratory dysfunction are risks. There is a growing consensus that spinal anaesthesia is safe, effective and technically simple to perform in this group of patients. We present a survey of 515 consecutive anaesthetics in cord-injured patients and a review of the current literature on anaesthesia for patients with chronic spinal cord lesions. Dramatic improvements in the care of spinal cord injury patients have been achieved over the last few decades [1]. The active management of urinary tract and respiratory complications has lead to a decrease in mortality from renal and respiratory failure. Overall mortality decreased from over 80% at the time of World War I to less than 2% by the early 1980s. The implications of increased survival are an increase in the prevalence of spinal cord injuries, an increase in the numbers of patients presenting for elective surgery and an ever increasing number of spinal cord injured patients who develop further medical conditions as the result of normal ageing.Although the majority of spinal cord injured patients currently undergo elective surgery in specialised spinal units, the appearance of such patients on operating lists of other hospitals is likely to increase. Anaesthesia in the cord-injured patient poses unique difficulties. An understanding of the relevant pathophysiology assists in the provision of safe peri-operative care.

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Succinylcholine, paraplegia, and intraoperative cardiac arrest. A case report.

Cited by 7 publications

References 0 publications

A Comparison of Succinylcholine and Rocuronium for Rapid‐sequence Intubation of Emergency Department Patients

A Comparison of Succinylcholine and Rocuronium for Rapid‐sequence Intubation of Emergency Department Patients

Influence of chronic and acute spinal cord injury on skeletal muscle Na⁺-K⁺-ATPase and phospholemman expression in humans

Anaesthesia for chronic spinal cord lesions

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Succinylcholine, paraplegia, and intraoperative cardiac arrest. A case report.

Cited by 7 publications

References 0 publications

A Comparison of Succinylcholine and Rocuronium for Rapid‐sequence Intubation of Emergency Department Patients

A Comparison of Succinylcholine and Rocuronium for Rapid‐sequence Intubation of Emergency Department Patients

Influence of chronic and acute spinal cord injury on skeletal muscle Na+-K+-ATPase and phospholemman expression in humans

Anaesthesia for chronic spinal cord lesions

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Product

Resources

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Influence of chronic and acute spinal cord injury on skeletal muscle Na⁺-K⁺-ATPase and phospholemman expression in humans