A Defasciculating Dose of Nondepolarizing Neuromuscular Blocker

Chapter

Abstract

A 44-year-old obese man presented for open reduction and internal fixation of an ankle fracture. To prevent myalgia, a defasciculating dose of vecuronium was given prior to rapid-sequence induction of anesthesia with succinylcholine. The patient developed agitation and profound hypoxemia prior to direct laryngoscopy and placement of an endotracheal tube. Lessons discussed in this chapter include prevention of fasciculation, succinylcholine-related myalgia, and pulmonary effects of obesity.

Keywords

Obesity Fentanyl Lidocaine Midazolam Sevoflurane 

References

  1. 1.
    Horrow JC, Lambert DH. The search for an optimal interval between pretreatment dose of d-tubocurarine and succinylcholine. Can Anaesth Soc J. 1984;31:528–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Schreiber JU, Lysakowski C, Fuchs-Buder T, Tramèr MR. Prevention of succinylcholine-induced fasciculation and myalgia: a meta-analysis of randomized trials. Anesthesiology. 2005;103:877–84.PubMedCrossRefGoogle Scholar
  3. 3.
    Minton MD, Grosslight K, Stirt JA, Bedford RF. Increases in intracranial pressure from succinylcholine: prevention by prior nondepolarizing blockade. Anesthesiology. 1986;65:165–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Miller RD, Way WL. Inhibition of succinylcholine-induced increased intragastric pressure by nondepolarizing muscle relaxants and lidocaine. Anesthesiology. 1971;34:185–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Eisenkraft JB, Mingus ML, Herlich A, Book WJ, Kopman AF. A defasciculating dose of d-tubocurarine causes resistance to succinylcholine. Can J Anaesth. 1990;37:538–42.PubMedCrossRefGoogle Scholar
  6. 6.
    McLoughlin C, Elliott P, McCarthy G, Mirakhur RK. Muscle pains and biochemical changes following suxamethonium administration after six pretreatment regimens. Anaesthesia. 1992;47:202–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Erkola O, Salmenpera A, Kuoppamaki R. Five non-depolarizing muscle relaxants in precurarization. Acta Anaesthesiol Scand. 1983;27:427–32.PubMedCrossRefGoogle Scholar
  8. 8.
    Jones RL, Nzekwu MM. The effects of body mass index on lung volumes. Chest. 2006;130:827–33.PubMedCrossRefGoogle Scholar
  9. 9.
    Benumof JL, Dagg R, Benumof R. Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinylcholine. Anesthesiology. 1997;87:979–82.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of California, San DiegoSan DiegoUSA

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