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British Journal of Anaesthesia Dec 2015
Topics: Butyrylcholinesterase; Drug Administration Schedule; Drug Resistance; Humans; Neuromuscular Depolarizing Agents; Succinylcholine
PubMed: 26183168
DOI: 10.1093/bja/aev228 -
British Journal of Anaesthesia Jul 2015The bispectral index (BIS) monitor is a quantitative electroencephalographic (EEG) device that is widely used to assess the hypnotic component of anaesthesia, especially...
BACKGROUND
The bispectral index (BIS) monitor is a quantitative electroencephalographic (EEG) device that is widely used to assess the hypnotic component of anaesthesia, especially when neuromuscular blocking drugs are used. It has been shown that the BIS is sensitive to changes in electromyogram (EMG) activity in anaesthetized patients. A single study using an earlier version of the BIS showed that decreased EMG activity caused the BIS to decrease even in awake subjects, to levels that suggested deep sedation and anaesthesia.
METHODS
We administered suxamethonium and rocuronium to 10 volunteers who were fully awake, to determine whether the BIS decreased in response to neuromuscular block alone. An isolated forearm technique was used for communication during the experiment. Two versions of the BIS monitor were used, both of which are in current use. Sugammadex was used to antagonise the neuromuscular block attributable to rocuronium.
RESULTS
The BIS decreased after the onset of neuromuscular block in both monitors, to values as low as 44 and 47, and did not return to pre-test levels until after the return of movement. The BIS showed a two-stage decrease, with an immediate reduction to values around 80, and then several minutes later, a sharp decrease to lower values. In some subjects, there were periods where the BIS was <60 for several minutes. The response was similar for both suxamethonium and rocuronium. Neither monitor was consistently superior in reporting the true state of awareness.
CONCLUSIONS
These results suggest that the BIS monitor requires muscle activity, in addition to an awake EEG, in order to generate values indicating that the subject is awake. Consequently, BIS may be an unreliable indicator of awareness in patients who have received neuromuscular blocking drugs.
CLINICAL TRIAL REGISTRY NUMBER
ACTRN12613000587707.
Topics: Adult; Androstanols; Cognition; Electroencephalography; Electromyography; Female; Humans; Male; Middle Aged; Neuromuscular Blockade; Rocuronium; Succinylcholine; Volunteers; Wakefulness
PubMed: 26174308
DOI: 10.1093/bja/aev072 -
Anesthesiology Dec 2018Intracranial and Hemodynamic Changes after Succinylcholine Administration in Cats. By Cottrell JE, Hartung J, Giffin JP, and Shwiry B. Anesthesia & Analgesia 1983;...
Intracranial and Hemodynamic Changes after Succinylcholine Administration in Cats. By Cottrell JE, Hartung J, Giffin JP, and Shwiry B. Anesthesia & Analgesia 1983; 62:1006-9. Reprinted with permission.Bolus injections of succinylcholine (1.5 mg/kg) significantly increased intracranial pressure (ICP) in cats under normal conditions from control levels of 8 +/- 1 mmHg to 16 +/- 3 mmHg (+/- SEM, P less than 0.01), and in the presence of artificially increased ICP from control levels of 27 +/- 1 mmHg to 47 +/- 4 mmHg (P less than 0.01). These approximately 100% increases in ICP were accompanied by a transitory decrease in mean arterial pressure (approximately 10 s), followed by a 15 to 20% increase (P less than 0.05). Pulmonary arterial pressure increased 20 to 30% (P less than 0.05). These results, when considered in conjunction with results previously obtained in humans, suggest that succinylcholine may be contraindicated in neurosurgical patients.
Topics: Anesthesiology; Animals; Blood Pressure; Cats; Hemodynamics; History, 20th Century; Intracranial Pressure; Neuromuscular Depolarizing Agents; Succinylcholine
PubMed: 30222601
DOI: 10.1097/ALN.0000000000002429 -
Medicina Intensiva Mar 2015
Topics: Contraindications; Drug Utilization; Humans; Intubation, Intratracheal; Neuromuscular Depolarizing Agents; Succinylcholine; Time Factors
PubMed: 25449667
DOI: 10.1016/j.medin.2014.09.001 -
British Journal of Anaesthesia Feb 1982
Review
Topics: Adult; Aging; Animals; Butyrylcholinesterase; Child; Dose-Response Relationship, Drug; Drug Interactions; Electromyography; Fasciculation; Hemodynamics; Humans; Hyperkalemia; Infant; Infusions, Parenteral; Intraocular Pressure; Muscle Contraction; Pain; Stomach; Succinylcholine; Time Factors
PubMed: 7037028
DOI: 10.1093/bja/54.2.195 -
Anaesthesia Mar 2009No drugs in anaesthesia are more problematic than suxamethonium. Yet, no drugs have survived as suxamethonium does in spite of crisis after crisis, and attempt after... (Review)
Review
No drugs in anaesthesia are more problematic than suxamethonium. Yet, no drugs have survived as suxamethonium does in spite of crisis after crisis, and attempt after attempt at its replacement. For decades, suxamethonium has taught us neuromuscular pharmacology and provided us with an encyclopaedia of side effects, while benefiting millions and millions of our anaesthetised patients. With the arrival of sugammadex, it finally appears that suxamethonium can be retired. Suxamethonium has done its job and seen its days! The present review is intended to offer a eulogy for suxamethonium.
Topics: Anesthesia Recovery Period; Humans; Neuromuscular Blockade; Neuromuscular Depolarizing Agents; Neuromuscular Junction; Structure-Activity Relationship; Succinylcholine
PubMed: 19222434
DOI: 10.1111/j.1365-2044.2008.05873.x -
British Journal of Anaesthesia Jul 1994
Topics: Diclofenac; Humans; Muscular Diseases; Pain; Succinylcholine
PubMed: 8093161
DOI: 10.1093/bja/73.1.118 -
Anesthesiology Apr 2013
Topics: Androstanols; Anesthesia; Female; Humans; Male; Masks; Neuromuscular Blocking Agents; Respiration, Artificial; Succinylcholine
PubMed: 23511536
DOI: 10.1097/ALN.0b013e31828779b4 -
Anesthesiology Jan 1989
Topics: Humans; Succinylcholine; Trismus
PubMed: 2912302
DOI: 10.1097/00000542-198901000-00038 -
Anesthesiology Oct 2019
Topics: Anesthesia; Dantrolene; Succinylcholine
PubMed: 31453814
DOI: 10.1097/ALN.0000000000002949