Related Experiment Video
Updated: Jun 29, 2026
08:50
Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy
Published on: June 25, 2013
Succinylcholine: a drug to avoid in bariatric surgery
Talar Tejirian1, Catherine E Lewis, James Conner
1Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Obesity Surgery
|October 8, 2008
Summary
Succinylcholine, a common anesthetic paralytic, can cause severe muscle pain (myalgia). This case highlights the risks of using succinylcholine in bariatric surgery, recommending alternatives to prevent complications like prolonged hospital stays and pneumonia.
Area of Science:
- Anesthesiology
- Surgical Complications
Background:
- Succinylcholine is a widely used depolarizing neuromuscular blocking agent in anesthesia.
- Adverse effects of succinylcholine range from mild to life-threatening.
- Succinylcholine myalgia is a known, albeit variable, complication.
Observation:
- A 34-year-old female patient received succinylcholine during laparoscopic Roux-en-Y gastric bypass surgery.
- Postoperatively, the patient developed significant succinylcholine myalgia.
- This complication led to an extended hospital admission and the development of pneumonia.
Findings:
- The patient's myalgia significantly impacted her recovery and necessitated prolonged care.
- The case underscores the potential for severe adverse events following succinylcholine administration in this surgical context.
- Alternative paralytic agents exist that may offer a safer profile for bariatric procedures.
Implications:
- Succinylcholine should be judiciously considered, and potentially avoided, in patients undergoing bariatric surgery.
- Specialized anesthesia teams experienced in bariatric surgery can optimize patient management.
- Minimizing peri-operative complications is crucial for improved patient outcomes in bariatric surgery.
Related Concept Videos
01:19Depolarizing Blockers: Pharmocokinetics
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
01:21Skeletal Muscle Relaxants: Adverse Effects
Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Unlike...
01:28Depolarizing Blockers: Mechanism of Action
Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because succinylcholine...
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because succinylcholine...
01:31Skeletal Muscle Relaxants: Therapeutic Uses
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...
01:27Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions
Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Although all competitive neuromuscular blockers are designed...
01:17Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action
Nondepolarizing neuromuscular blockers induce paralysis by competitively blocking nicotinic acetylcholine receptors at the muscle end plate. Examples include pancuronium, mivacurium, vecuronium, and rocuronium. These quaternary ammonium derivatives are administered intravenously, are poorly absorbed, and are excreted via the kidneys.
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...