Repeat dose of succinylcholine

[Dr. Mian]

I recently had a nearly very bad situation when I repeated 1/2 a dose of succinylcholine (about 5 min after the original dose) to a healthy 23 y/o male.  Unknown to me, on further reading, I found this to be a well recognized complication of succinylcholine; especially because I have done this often in the past when managing difficult airways.

Does anyone else have similar experiences?

Does anyone have any experience using succinylcholine for very short term muscle relaxation when requested by the surgeon?

[yogenbhatt1]

Only you did not mention what was the complication.
And if anyone says that he has not seen a scoline apneoa or repeat dose Brady, it means he is too young, of lucky. All my gen people have seen and dreaded the complications. Our time the choice was between Galamine and Scoline. The later was better by any standard, fpr short cases.
We have also heard of Brady leading to Asystole and not picking up.
But still a better choice as a drug in many patients.

[anaesami]

i have frequently administered repeat does of suxa, sometimes even 3 successive doses; generally i co-administer a small doose of atropine 0.2 mg along with the repeat dose. even with this sometomes brady occured but not of alarming degree.

[jafo1964]

Dear doc
Literature does not support the use of multiple doses of succinylcholine due to problems like  phase 2 block, desensitization block and brady-asystolic arrhythmias due to ganglion stimulation.
I am sure you have enough experience with multiple dosing.
A dose of Suxa has a duration of action ranging from 5 to 15 minutes.
So 3 doses may produce relaxation for about 30 minutes.
You could have achieved the same with a single dose of intermediate duration of action NDP relaxant. The choices would include Atracurium, Cisatracurium, Vecuronium and Rocuronium.
I think this would be a better accepted practice from medicolegal point of view.
In olden days even suxa infusions have been used. Those days of medical practice without evidence are over.
I do agree that complications with suxa are extremely rare.
However in view of available evidence even if 1 person has adverse outcome due to multiple suxa dosing, it will completely be unacceptable.
We do not use multiple suxa doses.
Infact we don't use suxa at all. We prefer direct NDP even for intubation unless there is a very strong indication for use of Suxa

regs

[anaesami]

dear jafo, you are quite right. the repeat suxa was necessary because of somewhat unexpected prolongation of the minor surgical procedure originally expected to be finished with a single dose of suxa. it was a counsel of desperation.  and not of voluntary choosing. however, for intubation we prefer suxa especially in cases where some difficulty in laryngoscopy or intubatioon is expected.

[peeciss]

i agree with jafo, but might add: why don't you just turn up your sevoflurane, if it's an unexpected, short term prolongation of your attended surgery?