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Succinylcholine, fasciculations and myoglobinaemia

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Abstract

The prophylactic effectiveness of a small “self-taming” dose of succinylcholine (0.1 mg.kg-1), of d-tubocurarine (0.05 mg.kg-1), and of pancuronium (0.02 mg.kg-1) on succinylcholine-induced fasciculations and myoglobinaemia was studied in 64 healthy children (ages two to nine years), anaesthetized with halothane, nitrous oxide and oxygen. Serum myoglobin was analyzed by radio-immunoassay and taken as a tracer of muscle damage. No correlation was found between the serum levels of myoglobin and the incidence of muscle fasciculations. Self-taming with succinylcholine decreased the incidence of fasciculations (p = 0.001) but did not decrease the succinylcholine-induced myoglobinaemia (p = 0.224).

D-tubocurarine (0.05 mg.kg-1) and pancuronium (0.02 mg.kg-1) both significantly reduced the myoglobinaemia and the fasciculations produced by succinylcholine. The pancuronium pretreated group presented less variable values of serum myoglobin which, when compared to the control group, had a more significant p value (p < 0.001) than for d-tubocurarine pretreated group (p = 0.003). Muscle fasciculations and increased myoglobin levels were observed in children less than four years old who received succinylcholine.

The prophylaxis of acute rhabdomyolytic renal failure due to succinylcholine (seven cases reported in the medical literature) is considered.

Résumé

Les auteurs ont étudié la valeur prophylactique d’une petite dose de succinylcholine IV (0.1 mg.kg-1), de la d-tubocurarine (0.05 mg.kg-1) et du pancuronium (0.02 mg.kg-1), contre les fasciculations musculaires et contre I’ hypermyoglobinémie normalement déclenchées par la succinylcholine IV, particulièrement chez les enfants. Cette étude porte sur 64 enfants (de deux à neuf ans; état physique I de la classification ASA), anesthésiés à I’aide de I’halothane, protoxyde d’azote et oxygène. La myoglobine sérique, mesurée par radio-immunoessai, a été choisie en tant que valeur indicatrice de lésion musculaire. Aucune correlation n’a été trouvée entre I’incidence de fasciculations musculaires et les niveaux sériques de myoglobine. Le prétraitement avec de la succinylcholine (0.1 mg.kg-1) IV a dimunué I’incidence de fasciculations musculaires (p = 0.001) sans, toutefois, offrir aucune protection contre L’ hypermyoglobinemieinduite par la succinylcholine (p = 0.224). Les prétritements avec de la d-tubocurarine (0.05 mg.kg-1) et avec du pancuronium (0.02 mg.kg-1), par voie intraveineuse, ont apporté des diminutions statistiquement significatives de l’hypermyoglobinémie induite par la succinylcholine IV. La comparaison directe entre ces deux groupes (d-tubocurarine versus pancuronium) ne s’est pas révélée significative. Cependant, il faut noter que le groupe prétraité avec du pancuronium a présenté des valeurs de myoglobine sérique moins discordants et une valeur de p plus significative (p < 0.001) que le groupe prétraité avec de la d-tubocurarine (p = 0.003), lorsque chaque groupe a été comparé avec le groupe servant de contrôle (succinylcholine IV sans aucun pritraitement).

Des fasciculations musculaires et des élévations de la myoglobine sérique ont été observées chez des enfants de moins de quatre ans.

La prophylaxie de l’insujfisance rénale aiguë par rhabdomyolyse due à la succinylcholine intraveineuse (plutot rare : sept cas rapportés dans la littérature m&édicale) est envisagée.

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Correspondence to Victor Faria Blanc or Guy Vaillancourt or Gilles Brisson.

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Faria Blanc, V., Vaillancourt, G. & Brisson, G. Succinylcholine, fasciculations and myoglobinaemia. Can Anaesth Soc J 33, 178–184 (1986). https://doi.org/10.1007/BF03010829

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Key words

  • anaesthesia
  • paediatric
  • complications
  • muscle fasciculations myoglobinaemia
  • rhabdomyolysis
  • prophylaxis
  • pretreatment
  • self-taming
  • neuro-muscular relaxants
  • d-tubocurarine
  • pancuronium
  • succinylcholine