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Optimal dose of succinylcholine revisited
Mohamed Naguib1, Abdulhamid Samarkandi, Waleed Riad
1Department of Anesthesia, University of Iowa College of Medicine, Iowa City, Iowa 52242, USA.
Anesthesiology
|October 25, 2003
Summary
The standard 1.0 mg/kg dose of succinylcholine for intubation may be excessive. A dose of 0.56 mg/kg provides acceptable intubating conditions in 95% of patients, potentially allowing faster recovery.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Conventional wisdom suggests 1.0 mg/kg succinylcholine is necessary for intubation.
- This study aimed to determine the minimum effective succinylcholine dose for optimal intubation conditions.
Purpose of the Study:
- To re-evaluate the standard intubating dose of succinylcholine.
- To define a lower succinylcholine dosage range for acceptable intubation in 95% of patients within 60 seconds.
Main Methods:
- Prospective, randomized, double-blind study with 200 patients.
- Anesthesia induced with fentanyl and propofol.
- Patients received varying doses of succinylcholine (0.3, 0.5, 1.0 mg/kg) or saline.
- Intubating conditions assessed 60 seconds post-administration.
Main Results:
- Acceptable intubating conditions were achieved in 92-98% of patients with 0.3-1.0 mg/kg succinylcholine.
- The calculated dose for 95% acceptable intubating conditions at 60s was 0.56 mg/kg (95% CI 0.43-0.73).
- No significant difference in intubating conditions was observed between 0.3, 0.5, and 1.0 mg/kg succinylcholine groups.
Conclusions:
- The 1.0 mg/kg succinylcholine dose may be excessive for rapid-sequence intubation.
- 0.56 mg/kg succinylcholine is sufficient for acceptable intubation in 95% of patients.
- Lower succinylcholine doses may facilitate quicker recovery of spontaneous respiration and reflexes.