Suxamethonium-induced hyperkalaemia in patients with severe intra-abdominal infections

In nine patients, undergoing repeat operations because of severe intra-abdominal infection developing after major abdominal surgery, serum potassium concentrations were monitored during induction of anaesthesia. Four patients showed an increase of serum potassium ranging from 2.5 to 3.1 mmol/litre above baseline values within 3-6 min after suxamethonium 100 mg i.v. In five patients there was no change. The four patients demonstrating an increase had suffered from pyrexia and leucocytosis for at least 2 weeks. The other five had signs of infection for no more than 9 days. It is concluded that patients with signs of severe intra-abdominal infection lasting longer than 1 week represent an additional category susceptible to suxamethonium-induced hyperkalaemia. They should receive only non-depolarizing muscle relaxants. When the use of suxamethonium is unavoidable, the injection of a non-depolarizing muscle relaxant before the administration of suxamethonium is recommended.