Treatment of Sarin Exposure

Abstract

cide poisoning. 3 The duration of paralysis in most cases, however, was less than 4 hours. Similar prolongation of neuromuscular blockade has been reported for mivacurium, a nondepolarizing neuromuscular blocker (NMB) that is also metabolized by butyrylcholinesterase. [4][5][6] Although muscle relaxants such as succinylcholine are generally necessary for rapid intubation, they can also exacerbate the underlying pathophysiology of sarin poisoning. One response to this dilemma would be to use a nondepolarizing NMB such as rocuronium. The appropriate dose of NMB has not been described for this clinical situation, although one would expect increased sensitivity (ie, prolonged duration) to nondepolarizing NMBs. 7 We thus propose that a reduced dose of succinylcholine should be used in patients who require rapid sequence intubation after exposure to sarin or other acetylcholinesterase inhibitors. With a reduced dose, the patient should experience even less than the usual duration of paralysis, which is a brief time in the context of sarin exposure. Of 640 patients following the Tokyo sarin attack of 1995, only 4 required intubation and none were extubated until the following day or later. 8