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[Curare and burns]

C Badetti1, J C Manelli

  • 1Département d'Anesthésie-Réanimation et Centre Régional des Grands Brûlés, Hôpital de la Conception, Marseille.

Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1994
PubMed
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Major burns significantly alter drug pharmacokinetics, particularly muscle relaxants. Succinylcholine is contraindicated post-burn due to hyperkalemia risk, while non-depolarizing agents show resistance, both linked to burn severity and recovery time.

Area of Science:

  • Anesthesiology
  • Burn Trauma
  • Pharmacology

Background:

  • Major burns (>15% TBSA) induce profound physiological changes affecting cardiovascular, pulmonary, hepatic, and renal functions.
  • These changes significantly alter drug pharmacokinetics and pharmacodynamics, impacting anesthetic management.
  • Muscle relaxant activity is notably affected in burn patients, necessitating careful consideration.

Purpose of the Study:

  • To investigate the altered response to muscle relaxants in patients recovering from burn trauma.
  • To elucidate the mechanisms behind succinylcholine contraindication and non-depolarizing muscle relaxant resistance post-burn.
  • To provide guidance on the safe use of neuromuscular blocking agents in burn management.

Main Methods:

  • Review of physiological changes following major burns.

Related Experiment Videos

  • Analysis of pharmacokinetic and pharmacodynamic alterations of muscle relaxants.
  • Examination of acetylcholine receptor modifications in burn patients.

    • Main Results:

    • Succinylcholine is contraindicated from day 5 post-burn for up to two years due to unpredictable hyperkalemic response and cardiac complications.
    • Small doses of succinylcholine reveal hypersensitivity but do not cause metabolic disturbances or cardiac arrest.
    • Non-depolarizing muscle relaxants exhibit resistance, peaking between days 15-40 and persisting for up to two years, correlated with burn area and delay.

    Conclusions:

    • Altered acetylcholine receptor expression (epsilon subunit replaced by gamma) in burn patients explains hyperkalemic response and succinylcholine hypersensitivity.
    • Resistance to non-depolarizing muscle relaxants is a significant factor in anesthetic management of burn survivors.
    • Careful timing and selection of neuromuscular blocking agents are crucial for safe anesthetic practice in burn recovery.