Suxamethonium‐related hyperkalaemic cardiac arrest in intensive care

Airway Management of the Critically Ill Patient*

“…The hyperkalemic effect may be exaggerated in patients with subacute or chronic denervation conditions (eg, congenital or acquired myopathies, cerebrovascular accidents, prolonged pharmacologic neuromuscular blockade, wound botulism, critical illness polyneuropathy, corticosteroid myopathies, and muscle disuse atrophy), burns, intraabdominal infections, sepsis, and muscle crush injuries. 81,83,[87][88][89][90][91] The exaggerated hyperkalemic response is mediated through the up-regulation of skeletal muscle nicotinic acetylcholine receptors. 88 Acute rhabdomyolysis can produce hyperkalemia, which is aggravated by the effects of succinylcholine, through mechanisms of drug-induced increases in muscle cell membrane permeability.…”

Suxamethonium and Critical Illness Polyneuropathy

“…Our principal finding was that 68.7% of respondents chose to use suxamethonium when there was a high likelihood that the patient had CIP. This is a dramatic result because there is no doubt that the use of suxamethonium in patients with critical illness polyneuropathy is potentially fatal [5][6][7][8] . The patient described is at high risk of CIP because he is a long-term patient (over seven days) and has had severe sepsis, after which the incidence of CIP is approximately 70% [9][10][11][12] .…”

“…Hyperkalaemia in response to administration of suxamethonium is a well recognised phenomenon in certain conditions such as burns and acute denervation in spinal injury 1. Acute weakness syndromes have been recognised in critically ill patients since 1974 2 , and the term critical illness polyneuropathy (CIP) was coined in 1983 3,4 . The life-threatening consequences of suxamethonium administration to patients with CIP were described initially in 1990 [5][6][7] and again more recently 8 : essentially, the result may be an almost immediate rise in serum potassium of up to 5 mmol.l -1 and resultant ventricular fibrillation or other life-threatening dysrhythmia. We carried out a questionnaire survey of intensive care units to determine the level of recognition of both CIP and, more specifically, the contraindication to suxamethonium in CIP.…”