Department of Anesthesiology

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Clinical characteristics of long-term succinylcholine neuromuscular blockade during balanced anesthesia.

TitleClinical characteristics of long-term succinylcholine neuromuscular blockade during balanced anesthesia.
Publication TypeJournal Article
Year of Publication1980
AuthorsRamsey FM, Lebowitz PW, Savarese JJ, Ali HH
JournalAnesth Analg
Volume59
Issue2
Pagination110-6
Date Published1980 Feb
ISSN0003-2999
KeywordsAdult, Aged, Anesthesia, General, Cholinesterase Inhibitors, Drug Administration Schedule, Electric Stimulation, Humans, Middle Aged, Succinylcholine, Time Factors, Ulnar Nerve
Abstract

Thumb adductor twitch response to train-of-four (2 Hz for 2 seconds) stimulation of the ulnar nerve was used to assess the clinical characteristics of long-term neuromuscular blockade induced with continuous infusion of succinylcholine during balanced (N2O-O2-narcotic-thiopental) anesthesia. Twitch depression of 80 to 90% was maintained for 86 to 365 minutes by continuous infusion of succinylcholine at 86 +/- 5(SEM) micrograms/kg/min. Of 32 patients, 24 developed phase II block, defined as a train-of-four ratio of less than 50%. There was a large degree of individual variability in sensitivity to development of phase II block. This precluded defining a narrow dose range where transition from phase I to phase II occurred. Tachyphylaxis occurred in 25% of patients and was independent of the type of block. Neither dose nor duration of infusion was predictive of spontaneous recovery rate from phase II block. Of 24 patients who developed phase II block, 50% recovered spontaneously at a rate comparable to the recovery rate from a phase I block. The other 50% manifested prolonged recovery of neuromuscular function. After observing spontaneous recovery in these patients for 31 +/- 5(SEM) minutes, successful antagonism of residual phase II block with anticholinesterase agents was achieved.

Alternate JournalAnesth. Analg.
PubMed ID7189331