Cardiac effects of self-taming of succinylcholine and repeated succinylcholine administration

Pretreatment with small (10 mg) doses of succinylcholine ("self-taming") decreases the incidence of muscle fasciculations following succinylcholine administration and may decrease the incidence of other unwanted effects. This study was designed to assess the cardiac effects of such self-taming and to assess the degree of protection afforded against bradydysrhythmias following subsequent succinylcholine administration. Sixty patients were studied and allocated randomly to three groups of twenty. Each group was assigned a different form of pretreatment. Patients in group I received 10 mg of succinylcholine immediately after induction. Patients in group II were treated with d-tubocurarine 0.04k mg . kg-1 three minutes before induction. Patients in group III received no pretreatment. All patients were induced with thiopentone 4 mg . kg-1 followed by succinylcholine 1 mg . kg-1 45 seconds later. A second dose of succinylcholine 1 mg . kg-1 was administered to the patients in the two pretreatment groups between four and five minutes after the first dose of succinylcholine. Following both the first and second doses of succinylcholine patients in the self-taming group showed a significantly greater incidence of bradydysrhythmias when compared to the other two groups. It is concluded that the use of a self-taming technique is potentially hazardous, and that it does not confer protection against repeated succinylcholine administration.