The effect of suxamethonium on intracranial pressure and cerebral perfusion pressure in patients with severe head injuries following blunt trauma

Brown, M. M.; Parr, Michael J.; Manara, Alex

doi:10.1046/j.1365-2346.1996.00973.x

Cited by 18 publications

(4 citation statements)

References 7 publications

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“…177 For acute traumatic injury, only a few studies have been conducted. One study failed to demonstrate any significant increase in ICP or change in cerebral perfusion following an intubation dose of succinylcholine given to patients with severe head trauma 178 [II]. One systematic review did not find evidence of any benefit from preinduction doses of non-depolarizing NMBAs before succinylcholine in patients with acute brain injury.…”

Section: Introductionmentioning

confidence: 99%

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Jensen

Callesen

Hagemo

et al. 2010

Acta Anaesthesiol Scand

115

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Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high‐grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre‐operative gastric emptying is rarely indicated. For pre‐oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre‐oxygenation in the obese patients should be performed in the head‐up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1–1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.

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Section: Introductionmentioning

confidence: 99%

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Jensen

Callesen

Hagemo

et al. 2010

Acta Anaesthesiol Scand

115

View full text Add to dashboard Cite

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“…A total of 22 prospective studies (including small RCTs) were identified. Seven of them evaluated the ability of different NMBAs (including succinylcholine) in preventing surges of ICP after patient's stimulation with endotracheal suctioning [8][9][10][11][12], fiberoptic bronchoscopy [20], or physiotherapy [21]. In these studies, a bolus of different NMBAs was effective in preventing ICP increasedue to endotracheal suctioning or physiotherapy.…”

Section: Randomized Controlled Trials and Prospective Studiesmentioning

confidence: 99%

“…Neuromuscular blockers have shown their ability in preventing fluctuations of ICP due to coughing stimulating maneuvres [8][9][10][11][12]21]. Nevertheless, more invasive procedures, such as fiberoptic bronchoscopy, did not get much benefit from administration of NMBA [20], even though a confounding effect by fluctuating CO 2 cannot be excluded.…”

Section: Potential Advantages Of Treatment With Nmbas After Traumatic...mentioning

confidence: 99%

The Role of Neuromuscular Blockade in Patients with Traumatic Brain Injury: A Systematic Review

et al. 2014

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Management of Traumatic Brain Injury (TBI) focuses on controlling intracranial pressure (ICP), while other treatments, such as the use of neuromuscular blocking agents (NMBAs), need scientific evidence. We conducted a systematic review to investigate the usefulness of NMBAs in the context of TBI and/or increased ICP. We searched MEDLINE and EMBASE databases up to January 31st 2014, including both clinical and experimental findings. We found a total of 34 articles, of which 22 were prospective clinical trials. No systematic review/meta-analyses were found. Seven studies evaluated NMBA boluses in preventing stimulation-related ICP surges: paralysis was effective during tracheal suctioning and physiotherapy but not during bronchoscopy. Fourteen small studies (8 to 25 patients) assessed the effect of NMBA boluses on ICP. Two studies showed an ICP increase by succinylcholine and one found a decrease in ICP after atracurium. No ICP changes were observed in the other studies. One prospective study confirmed that discontinuing paralysis increases energy expenditure. Two retrospective studies investigated mortality/morbidity: one found that early paralysis (continued for >12 h) was not beneficial and potentially associated with extra-cranial complications, while the second demonstrated a correlation between continuous infusion of NMBA and time spent with ICP > 20 mmHg. Eight animal studies were also retrieved. In most studies, NMBA bolus was beneficial in controlling ICP, especially when performing stimulating procedures. However, retrospective evidence found potential harm by continuous NMBA infusion. In the context of TBI patients, we discuss the potentially positive effects of paralysis with its negative ones. Well-conducted randomized controlled trials and/or large pharmaco-epidemiologic studies are warranted.

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“…Suxamethonium had been shown to increase intracranial pressure in dogs 27 but clinical trial in patients with severe head injury found no significant change in intracranial pressure after administration of suxamethonium. 28 It is considered safe to administer suxamethonium in most neurosurgical patients 29 especially after smooth thiopentone-hyperventilation sequence. Some experienced anaesthesiologist may use an alternative technique when hyperventilation or thiopentone cannot be used 30 but this author would still recommend doctors with less experience to use suxamethonium under those circumstances.…”

Section: Suxamethoniummentioning

confidence: 99%

Rapid Sequence Induction and Intubation

2001

Hong Kong Journal of Emergency Medicine

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The modern version of RSI starts with preoxygenation. General anaesthesia is then induced using a rapid acting intravenous anaesthetic and a rapid acing muscle relaxant. Cricoid pressure is applied by an experienced assistant during induction, which should then be maintained until the trachea of the patient is intubated, correct positioning of the tracheal tube confirmed and the cuff inflated. The patient is conventionally not ventilated during this phase but critically ill patients are exceptions. The patient's tracheal should be intubated when adequately paralysed and its position verified. The assistant can then relieve the cricoid pressure and the tracheal tube fixed.

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The effect of suxamethonium on intracranial pressure and cerebral perfusion pressure in patients with severe head injuries following blunt trauma

Cited by 18 publications

References 7 publications

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

The Role of Neuromuscular Blockade in Patients with Traumatic Brain Injury: A Systematic Review

Rapid Sequence Induction and Intubation

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