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Depression is a common mental health problem that is associated with significant disability and mortality. Electroconvulsive therapy (ECT) has been demonstrated to be effective at resolving expression of suicidal intent in patients with depression. In less acute situations, patients are usually referred for ECT after several medication trials. Neuromuscular blocking agents (NMBAs) are used to block tonic-clonic motor activity and associated physical harm during the delivery of ECT. Succinylcholine (Sch), with its rapid onset of muscle relaxation, short self-terminating duration of action, and rapid subsequent return of spontaneous ventilation, is the NMBA of choice for ECT. However, the use of Sch is problematic or contraindicated is some situations. Although non-depolarizing NMBAs can be used, the variable time to onset of adequate muscle relaxation and prolonged duration of action have limited their widespread acceptance as alternatives to Sch. Recently, however, with the widespread availability of sugammadex, a chemically modified γ-cyclodextrin that rapidly and predictably reverses the effect of non-depolarizing NMBAs, the muscle relaxation achieved by rocuronium can predictably and effectively be reversed. In situations where Sch is contraindicated or otherwise problematic, rocuronium, followed by pharmacological antagonism with sugammadex, can provide a safe and effective muscle relaxation approach comparable to that of Sch in terms of duration of action. This review provides a summary of the current state of evidence for the use of sugammadex during ECT, which should lend support to further acceptance and future studies of sugammadex in the context of ECT. [ABSTRACT FROM AUTHOR]

Introduction: Suxamethonium chloride (SUX) is a short acting depolarizing muscle relaxant commonly used for medical procedures to induce respiratory paralysis. The case report aims to highlight the important postmortem findings associated with SUX poisoning. Case report: A female adult health-care worker in her thirties was found dead in her bedroom at home. There were two empty ampoules of IV/IM Suxamethonium Chloride 100 mg/2 ml found next to the body. Results: The autopsy revealed an adult female with multiple needle injection marks. Gross examination of the lungs showed markedly congested lungs and froth in the airways. The liver showed foci of petechial haemorrhages and confluent haemorrhages. Other internal organs showed diffuse vascular congestion. Microscopically, significant pathological changes were seen in the lungs and kidneys with areas of pulmonary infarction and acute tubular necrosis. SUX was not detected from the toxicological analysis. Correlating the circumstantial evidence at the scene of death, autopsy and microscopic findings, the cause of death was certified as SUX poisoning. Conclusions: We wished to demonstrate the autopsy and histopathological findings associated with acute SUX poisoning culminating in death due to respiratory paralysis. [ABSTRACT FROM AUTHOR]

Abstract Background Neuraxial anesthesia is the gold standard for cesarean sections, but general anesthesia is sometimes necessary, especially in emergency cases. Anaphylactic shock due to succinylcholine, a commonly used neuromuscular blocking agent, is rare but life-threatening. Case presentation A 42-year-old woman with severe preeclampsia and a history of intracranial vascular malformations underwent an emergency cesarean section. Induction with succinylcholine triggered an anaphylactic shock. Immediate intervention with epinephrine and corticosteroids stabilized the patient, allowing the safe delivery of a live infant. Discussion and conclusion This case highlights the need for rapid identification and management of anaphylactic shock during emergency cesarean sections under general anesthesia, especially in high-risk patients with complex medical histories.

INTRODUCTION: Rapid sequence induction is a conventional method used for airway management during anesthesia. Succinylcholine is considered standard neuromuscular blocking agent in rapid sequence induction but avoid the side effects of succinylcholine, rocuronium used as an alternative. Magnesium given as pretreatment before standard dose of rocuronium shortens the duration of onset of action of rocuronium and improve the intubating conditions. Aim of the study was to compare intubating conditions during rapid sequence induction between rocuronium with magnesium sulphate pretreatment, and succinylcholine in patients undergoing elective surgery under general anaesthesia. MATERIALS AND METHODS: In this Prospective comparative study, 150 patients were divided into 2 groups of 75 each. Group 1 patients were pretreated with magnesium sulphate 50 mg/kg in 100 ml 0.9% normal saline before induction and administration of rocuronium 0.6 mg/kg for intubation. Group 2 patients were given 100ml 0.9% normal saline before induction and succinylcholine 1.5 mg/kg was given for intubation. Intubating conditions were graded as excellent (score 8- 9), good (score 6-7), fair (3-5), poor (0-2) according to Cooper’s criteria. RESULTS: In 74 patients in each group, jaw relaxation was easy and in 1 patient in each group, it was fair (p=1). Vocal cords were found to be abducted in 70 patients (93.3%) in group 1 and 74 patients (98.7%) in group 2. Vocal cords were moving in 5 patients (6.6%) and 1 patient (1.3%) in group 1 and 2 respectively (p=0.209). There was no response to intubation in 67 patients (89.3%) and 73 patients (97.3%) in group 1 and 2 respectively. 8 patients (10.6%) in group 1 and 2 patients (2.7%) in group 2 had slight diaphragmatic movement. (p=0.097). 71 patients (94.6%) in group 1 and 74 patients (98.7%) in group 2 had excellent intubating conditions. 4 patients in group 1 and 1 patient in group 2 had good intubating conditions. Intubating conditions were comparable between both the groups (p=0.366). CONCLUSIONS: The study concluded that magnesium pretreatment before 0.6 mg/kg rocuronium provides clinically acceptable intubating conditions similar to succinylcholine making it suitable for rapid sequence induction with mild adverse effects which resolve spontaneously without any treatment.

Background: Electroconvulsive therapy (ECT) is widely accepted as a safe and effective treatment in psychiatric patients. Although succinylcholine is the choice of muscle relaxant in this process, its adverse effects and contraindications must be considered. Objectives: This study investigated the efficacy of cisatracurium as an alternative in ECT patients. Materials & Methods: This single-blind clinical trial was performed in an academic hospital in Northern Iran from July 2023 to March 2024. A total of 62 eligible ECT patients were enrolled in the survey and randomly divided into succinylcholine (0.5 mg/kg) and cisatracurium (0.1 mg/kg) groups. Seizure duration, mean arterial pressure, heart rate, the time to return to spontaneous breathing, and recovery time were recorded and compared between the two groups. Results: No significant difference was observed between the two groups regarding seizure duration and hemodynamic parameters (P>0.05). However, the time to return to spontaneous breathing (P=0.0001) and recovery time (P=0.0001) were significantly longer in the cisatracurium group. None of the patients was affected by serious adverse effects. Conclusion: Cisatracurium is a safe alternative to succinylcholine and can be administrated during ECT.

Background: Neuraxial anesthesia is the gold standard for cesarean sections, but general anesthesia is sometimes necessary, especially in emergency cases. Anaphylactic shock due to succinylcholine, a commonly used neuromuscular blocking agent, is rare but life-threatening. Case presentation: A 42-year-old woman with severe preeclampsia and a history of intracranial vascular malformations underwent an emergency cesarean section. Induction with succinylcholine triggered an anaphylactic shock. Immediate intervention with epinephrine and corticosteroids stabilized the patient, allowing the safe delivery of a live infant. Discussion and conclusion: This case highlights the need for rapid identification and management of anaphylactic shock during emergency cesarean sections under general anesthesia, especially in high-risk patients with complex medical histories. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Malignant hyperthermia (MH) and anesthesia-induced rhabdomyolysis (AIR) are rare, yet life-threatening complications that need prompt therapeutic actions and logistic preparedness for treatment success. Both conditions are triggered by general anesthetics, particularly volatiles and depolarizing muscle relaxants. In comparison with MH, which is an inherited pharmacogenomic disease of calcium channel receptor subpopulation and arises only after trigger exposure, AIR has been described mostly in patients with muscular dystrophies. In perioperative settings, rhabdomyolysis is also observed during propofol infusion syndrome, neuroleptic malignant syndrome, and cocaine, heroin, and alcohol intoxication. Despite their diverse etiology, the main clinical manifestations of MH and AIR overlap: a hypermetabolic state, hyperpyrexia, hypercarbia, acute renal failure, and hyperkalemia progressing to cardiac arrest, making the therapeutic approach to the patient extremely difficult. Case Report: We present an unenviable and challenging clinical scenario of an obligatory general anesthesia with endotracheal intubation in a patient with difficult airways for breast conserving onco-surgery with simultaneous targeted intraoperative 20 Gy irradiation. The case was complicated even further by coincident suspicious clinical presentation of a mild and self-limited hypercarbia, together with a protracted rhabdomyolysis, without hyperpyrexia. Given the atypical and scarce clinical presentation leading to diagnosis uncertainty of MH or AIR, which was proved only after receiving the genetic results, dantrolene was not administered, and the patient underwent successful supportive treatment. Conclusions: The study points to the diagnostic dilemma - crisis event MH or AIR - and raises issues about possible preoperative preventive measures and treatment options in patients with an uncertain diagnosis. [ABSTRACT FROM AUTHOR]

Obstetric difficult airway management has emerged as a critical safety issue, and unsuccessful intubation can lead to morbidity and mortality. A literature review of difficult and failed obstetric intubations from the 1970s to 2015 shows that the incidence of failed intubation is unchanged, remaining at one per 390 anesthetics. Our obstetric case report highlights an obstetric difficult airway secondary to limited mouth opening; rescue of the airway with an i-gel®; and establishment of a definitive airway with the aid of an Aintree intubation catheter and flexible fiberoptic scope-guided intubation through the i-gel®, a second-generation supraglottic airway. [ABSTRACT FROM AUTHOR]

Objective: To explore T cell‐intrinsic mechanisms underpinning the mal‐differentiation of tissue‐resident memory T (Trm) cells in patients with rheumatoid arthritis (RA). Methods: Circulating T cells from patient with RA and healthy individuals were used for Trm cell differentiation. The role of Hobit in Trm differentiation was investigated through targeted silencing experiments. Psmb5 expression regulation was explored by identifying BRD2 as a key transcription factor, with the interaction validated through chromatin immunoprecipitation‐quantitative polymerase chain reaction. The impact of BRD2 succinylation on Trm differentiation was examined by manipulating succinyl‐CoA levels in T cells. Humanized NSG chimeras representing synovitis provided insights into Trm infiltration in RA synovitis and were used for translational experiments. Results: In patients with RA, a notable predisposition of CD4+ T cells toward differentiation into Trm cells was observed, demonstrating a positive correlation with the disease activity score 28. Remarkably, Hobit was a pivotal facilitator in the formation of RA CD4+ Trm cells. Mechanistic studies unveiled the dysregulation of proteasomal Psmb5 in T cells of patients with RA as the key factor contributing to elevated Hobit protein levels. The deficiency of proteasomal Psmb5 was intricately linked to BRD2, with succinylation exerting a significant impact on Psmb5 transcription and Trm cell differentiation. This heightened BRD2 succinylation was attributed to elevated levels of mitochondrial succinyl‐CoA in RA T cells. Consequently, targeting succinyl‐CoA within CD4+ T cells controlled the inflammation of synovial tissues in humanized chimeras. Conclusion: Mitochondrial succinyl‐CoA fosters the succinylation of BRD2, resulting in compromised transcription of proteasomal Psmb5 and the differentiation of Trm cells in RA. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Rapid sequence induction is a conventional method used for airway management during anesthesia. Succinylcholine is considered standard neuromuscular blocking agent in rapid sequence induction but avoid the side effects of succinylcholine, rocuronium used as an alternative. Magnesium given as pretreatment before standard dose of rocuronium shortens the duration of onset of action of rocuronium and improve the intubating conditions. Aim of the study was to compare intubating conditions during rapid sequence induction between rocuronium with magnesium sulphate pretreatment, and succinylcholine in patients undergoing elective surgery under general anaesthesia. MATERIALS AND METHODS: In this Prospective comparative study, 150 patients were divided into 2 groups of 75 each. Group 1 patients were pretreated with magnesium sulphate 50 mg/kg in 100 ml 0.9% normal saline before induction and administration of rocuronium 0.6 mg/kg for intubation. Group 2 patients were given 100ml 0.9% normal saline before induction and succinylcholine 1.5 mg/kg was given for intubation. Intubating conditions were graded as excellent (score 8- 9), good (score 6-7), fair (3-5), poor (0-2) according to Cooper's criteria. RESULTS: In 74 patients in each group, jaw relaxation was easy and in 1 patient in each group, it was fair (p=1). Vocal cords were found to be abducted in 70 patients (93.3%) in group 1 and 74 patients (98.7%) in group 2. Vocal cords were moving in 5 patients (6.6%) and 1 patient (1.3%) in group 1 and 2 respectively (p=0.209). There was no response to intubation in 67 patients (89.3%) and 73 patients (97.3%) in group 1 and 2 respectively. 8 patients (10.6%) in group 1 and 2 patients (2.7%) in group 2 had slight diaphragmatic movement. (p=0.097). 71 patients (94.6%) in group 1 and 74 patients (98.7%) in group 2 had excellent intubating conditions. 4 patients in group 1 and 1 patient in group 2 had good intubating conditions. Intubating conditions were comparable between both the groups (p=0.366). CONCLUSIONS: The study concluded that magnesium pretreatment before 0.6 mg/kg rocuronium provides clinically acceptable intubating conditions similar to succinylcholine making it suitable for rapid sequence induction with mild adverse effects which resolve spontaneously without any treatment. [ABSTRACT FROM AUTHOR]

Background: Electroconvulsive therapy (ECT) is widely accepted as a safe and effective treatment in psychiatric patients. Although succinylcholine is the choice of muscle relaxant in this process, its adverse effects and contraindications must be considered. Objectives: This study investigated the efficacy of cisatracurium as an alternative in ECT patients. Materials & Methods: This single-blind clinical trial was performed in an academic hospital in Northern Iran from July 2023 to March 2024. A total of 62 eligible ECT patients were enrolled in the survey and randomly divided into succinylcholine (0.5 mg/kg) and cisatracurium (0.1 mg/kg) groups. Seizure duration, mean arterial pressure, heart rate, the time to return to spontaneous breathing, and recovery time were recorded and compared between the two groups. Results: No significant difference was observed between the two groups regarding seizure duration and hemodynamic parameters (P>0.05). However, the time to return to spontaneous breathing (P=0.0001) and recovery time (P=0.0001) were significantly longer in the cisatracurium group. None of the patients was affected by serious adverse effects. Conclusion: Cisatracurium is a safe alternative to succinylcholine and can be administrated during ECT. [ABSTRACT FROM AUTHOR]

Background Succinylcholine is commonly used as a neuromuscular blocker during electroconvulsive therapy (ECT), but it can induce myalgia in patients. Dexmedetomidine, an alpha-2 adrenergic agonist, may mitigate this side effect. This study investigates the efficacy of dexmedetomidine in reducing succinylcholine-induced myalgia in ECT patients. Materials and Methods We conducted a randomized, double-blind clinical trial involving 100 patients scheduled for ECT. Participants were divided into two groups: the dexmedetomidine group (n=50) received 1 µg/kg dexmedetomidine prior to succinylcholine administration, while the control group (n=50) received a placebo. Myalgia was assessed using a numerical rating scale (0-10) 24 hours post-ECT. Results The dexmedetomidine group reported a significantly lower incidence of myalgia (20%) compared to the control group (48%) (p < 0.01). The mean myalgia score in the dexmedetomidine group was 2.1 ± 1.3, while the control group had a mean score of 4.8 ± 2.5 (p < 0.01). No significant adverse effects were noted in either group. Conclusion Dexmedetomidine significantly reduces the incidence and severity of succinylcholine-induced myalgia in patients undergoing ECT. This finding supports the use of dexmedetomidine as a premedication option in this population. [ABSTRACT FROM AUTHOR]

Pawe&lstrok; Radkowski,1– 3 Maria Agnieszka Derkaczew,2 Micha&lstrok; Adam Jacewicz,4,5 Dariusz Onichimowski1,2 1Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, Olsztyn, Poland; 2Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland; 3Hospital zum Heiligen Geist, Fritzlar, Germany; 4Regional Specialist Hospital in Olsztyn, Olsztyn, Poland; 5Department of Pharmacology and Toxicology, Faculty of Medicine, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, PolandCorrespondence: Maria Agnieszka Derkaczew, Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland, Email m.derkaczew@gmail.comAbstract: The prevalence of morbid obesity in today’s population around the world is alarming. Morbid obesity involves substantial changes in body composition and function, which can affect the pharmacodynamics and pharmacokinetics of many drugs. This paper aims to discuss the application of muscle relaxants and their reversing agents in patients with morbid obesity. This work is based both on the available literature and the author’s personal experience. Dosage recommendations for muscle relaxants in morbidly obese patients are as follows: non-depolarizing relaxants like rocuronium, vecuronium, atracurium, and cisatracurium should be based on ideal body weight. Succinylcholine dosage should be adjusted to total body weight with a 200 mg maximum, while mivacurium should also be based on total body weight. Pancuronium is not used due to its long duration. Neostigmine dosing remains uncertain, but some suggest using total body weight. When it comes to Sugammadex opinions of the authors are divided, some indicate that it should be dosed based on ideal body weight, but more recent studies show that it should be based on 40% of corrected body weight.Keywords: muscle relaxants, muscle relaxants reversal agents, succinylcholine, sugammadex, morbid obesity, obese patients

Introduction: Postoperative myalgia in surgical patients is mainly caused by the routinely administered depolarizing muscle relaxant, Succinylcholine. There are many proposed strategies but no one were indicated as ideal preventive mechanisms for Succinylcholine induced post-operative myalgia. Even if data were sparse, Lidocaine pretreatment can reduce postoperative myalgia which requires further supportive evidences urging the initiation of this study. Methods: Prospective longitudinal cohort study was conducted from March to May 2021 at Dessie Comprehensive Specialized Hospital on 208 adult surgical patients. Patients pretreated with Lidocaine preoperatively were grouped as exposed and others as unexposed. Patients meeting the inclusion criteria during the study period were selected sequentially from the daily operation schedule list. Postoperative myalgia level was measured using post-operative myalgia survey repeatedly. The result was analyzed by Cochran's Q test and generalized estimating equation (GEE). Adjusted odds ratio with 95 % confidence interval and p value 0.05). Exposure to Lidocaine reduces postoperative myalgia significantly [AOR = 0.33, 95 % CI = (0.17,0.66)]. Multimodal analgesia [AOR = 0.32, 95 % CI = (0.18,0.55)], non-steroidal anti-inflammatory drugs alone [AOR = 0.47, 95 % CI = (0.29,0.76)], postoperative immobility [AOR = 0.61, 95 % CI = (0.47,0.8)], and being male [AOR = 0.48, 95 % CI = (0.26,0.87)] were other determinants in reducing Succinylcholine induced postoperative myalgia. Conclusion: Lidocaine pretreatment can significantly reduce the occurrence of Succinylcholine induced postoperative myalgia. Additionally, usage of multimodal analgesia with non-steroidal anti-inflammatory drugs or even only non-steroidal anti-inflammatory drugs in the intraoperative and postoperative period can reduce Succinylcholine induced postoperative myalgia.

The neuromuscular junction is a complex structure consisting of the muscle cell, the nerve terminal of a motor neuron and the synaptic cleft. It is the site of action for neuromuscular blocking drugs, which are a cornerstone of anaesthetic practice. These drugs can be divided into depolarizing and non-depolarizing drugs; the latter can be further subdivided into benzylisoquinolinium and aminosteroid compounds. Reversal agents are also discussed. The pharmacology of neuromuscular blocking drugs and reversal agents is discussed including mechanism of action, metabolism, factors influencing choice of drug as well as adverse effect profile. [ABSTRACT FROM AUTHOR]

The dose–response of intravenous lidocaine in preventing postoperative vomiting (POV) in children remains unclear. This study investigated whether intravenous lidocaine dose-dependently decreased POV risk within 24 h postoperatively in children undergoing tonsillectomy (with or without adenoidectomy) without severe complications. Patients aged 3–12 years (American Society of Anesthesiologists grade I–II) scheduled for elective tonsillectomy (with or without adenoidectomy) were enroled from December 2021 to March 2022. They were randomly grouped according to the lidocaine dose (A [0 mg kg−1], B [1 mg kg−1], C [1.5 mg kg−1], and D [2 mg kg−1]) and were administered the same induction protocol (sufentanil, propofol, and suxamethonium chloride). Anaesthesia was maintained with sevoflurane. The incidence of POV within 24 h postoperatively was 46, 40, 36, and 20% in groups A, B, C, and D, respectively, with significant differences between groups D and A. Postoperative analgesic rescues in groups A, B, C, and D were 62, 36, 34, and 16%, respectively, with significant differences between groups D and B, C and A, and D and A. No severe adverse events were reported. Intravenous lidocaine has a dose-dependent effect on reducing the risk of POV in children undergoing tonsillectomy (with or without adenoidectomy) without serious adverse events. Trial registration: Chinese Clinical Trial Registry, ChiCTR2100053006. [ABSTRACT FROM AUTHOR]

Background. Succinylcholine and rocuronium are the predominant neuromuscular blocking agents (NMBAs) used for rapid sequence intubation (RSI) in the emergency department (ED). Prior studies have found reduced first‐attempt intubation success (FAIS) with rocuronium compared to succinylcholine. Recent large registry data have shown no difference in intubating conditions or FAIS. Objectives. The objective of this study was to compare FAIS rates for rocuronium and succinylcholine when used for RSI in a high‐acuity academic ED. Methods. This was a single‐center retrospective study. Patients were included if they received either succinylcholine or rocuronium for RSI in the ED from January 2016 to August 2020. The primary endpoint was FAIS. Subgroup analyses were performed evaluating the impact of weight‐based dosing on FAIS for each agent, and multivariate analysis was conducted to evaluate the impact of baseline characteristics on the primary outcome. Results. There were 448 patients who received rocuronium and 183 patients who received succinylcholine. No difference was observed in unadjusted FAIS between patients receiving rocuronium (median weight‐based dose: 1.22 mg/kg) or succinylcholine (median weight‐based dose: 1.43 mg/kg) (361 (80.6%) vs. 150 (82.0%), p = 0.69). There were no differences in FAIS between the weight‐based dose categories for rocuronium and for succinylcholine. Conclusions. These findings were consistent with those from recent studies indicating no difference in FAIS between rocuronium and succinylcholine, although the median dose of rocuronium used in this study was higher than traditionally recommended. Larger prospective studies are warranted to further evaluate the effect of weight‐based paralytic dosing on FAIS. [ABSTRACT FROM AUTHOR]

Aim & Objective: The aim of this study was designed to compare the effect on Intraocular Pressure of Rocuronium with that of Succinylcholine during Rapid Sequence Induction of anaesthesia using Propofol and Fentanyl. Methodology: This was a sequential controlled study. The study was conducted at Apollo Institute of Medical Sciences & Research, Hyderabad, Telangana. Patients were allocated sequentially to one of two groups (n20 in each group) to receive Succinylcholine (group S) and Rocuronium (group R). All patients were medicated with Tab Alprazolam 0.5 mg orally night before surgery. Preoxygenation was done for 3 min, Anaesthesia was induced with Inj Fentanyl 2 mcg/kg and a sleep dose of Propofol given at a rate of 100 mg /min until loss of verbal response. Results: There was no significant difference between groups in Age, Sex, Weight, Propofol dose, Baseline IOP, Baseline MAP or Baseline HR. The difference in the changes in IOP between the Succinylcholine and Rocuronium groups was highly significant (P=0.001). Conclusion: To conclude Rocuronium bromide in a dose of 1 mg/kg Provides Good to Excellent intubating conditions comparable to that of Succinylcholine. It is a suitable agent for tracheal intubation in patients undergoing elective and emergency ophthalmic surgery where raise in intraocular pressure is undesirable. [ABSTRACT FROM AUTHOR]

Background: Suxamethonium is hydrolysed by butyrylcholinesterase (BChE) and a low BChE activity can result in a prolonged duration of action of suxamethonium. The BChE activity is reduced during pregnancy and postpartum period by up to 33%. However, it can also be reduced by mutations in the BChE gene. In this study, we assessed BChE activity and mutations in the BChE gene in pregnant and postpartum patients with prolonged duration of action of suxamethonium. It was hypothesised that at least 30% of patients with a low BChE activity did not have a mutation in the BChE gene. Methods: In this registry study we focused on pregnant and postpartum patients with a history of prolonged duration of action of suxamethonium referred to the Danish Cholinesterase Research Unit (DCRU) between March 2007 and January 2023. Primary outcome was the proportion of patients without a mutation among patients with a low BChE activity. Secondary outcomes were the proportion of patients with a low BChE activity and the proportion of patients with a mutation out of the total number of patients. Results: A total of 40 patients were included and among patients with a low BChE activity, 6% (95% CI: 1%–21%) did not have a mutation. Out of the total number of included patients referred to the DCRU, 90% (95% CI: 76%–97%) had a mutation and 94% (95% CI: 80%–99%) had a low BChE activity. Conclusion: Among pregnant and postpartum patients with a history of prolonged duration of action of suxamethonium and a low BChE activity, 6% did not have a mutation in the BChE gene. Our findings suggest that during pregnancy and postpartum clinically relevant prolonged duration of action of suxamethonium rarely occurs in genotypically normal patients. [ABSTRACT FROM AUTHOR]

Abstract Background Malignant hyperthermia is a potentially lethal condition triggered by specific anesthetic drugs, especially a depolarizing muscle relaxant of succinylcholine (Suxamethonium). Despite the frequent use of succinylcholine with electroconvulsive therapy (ECT), there has been no reported case of potentially lethal malignant hyperthermia following ECT. In addition, the time interval between the administration of succinylcholine and the onset of malignant hyperthermia has not been outlined in the context of ECT. Case presentation We present the case of a 79-year-old woman suffering from severe depression, who experienced severe malignant hyperthermia due to succinylcholine administration during an ECT session. She presented with a high fever of 40.2 °C, tachycardia of 140/min, hypertension with a blood pressure exceeding 200 mmHg, significant muscle rigidity, and impaired consciousness. These symptoms emerged two hours after ECT, which occurred in a psychiatric ward rather than an operating room, and reached their peak in less than 24 h. She was given 60 mg of dantrolene, which quickly reduced the muscular rigidity. Subsequently, she received two additional doses of 20 mg and 60 mg of dantrolene, which brought her fever down to 36.2 °C and completely eased her muscle rigidity within two days after ECT. Conclusions This is the first reported case of potentially lethal malignant hyperthermia after ECT. In addition, it highlights the delayed onset of malignant hyperthermia following an ECT procedure, emphasizing the necessity for psychiatrists to recognize its onset even after the treatment. In the light of potentially lethal consequences of malignant hyperthermia, it is critically important for psychiatrists to closely monitor both intraoperative and postoperative patient’s vital signs and characteristic physical presentations, promptly identify any symptomatic emergence, and treat it immediately with dantrolene.

Background and Aim: Electroconvulsive therapy (ECT) is an effective intervention for psychiatric patients. Succinylcholine is considered the drug of choice for muscle relaxation for ECT. Significant adverse effects of succinylcholine include fasciculation and myalgia. Dexmedetomidine is a highly selective α-2 adrenergic agonist. This study aims to determine the efficacy of a low dose of dexmedetomidine in reducing succinylcholine-induced myalgia in patients receiving ECT. Methods: This randomised controlled trial was conducted on 100 patients, aged 18–65 years, undergoing ECT, who were randomly allocated into two groups with an allocation ratio of 1:1. Group D received intravenous (IV) dexmedetomidine 0.25 µg/kg, and Group C received IV normal saline (0.9%). Patients’ self-reported myalgia scores were measured after 60 min of the procedure. Fasciculations were noted after IV succinylcholine administration. Heart rate (HR) and mean blood pressure (MBP) were measured at baseline, after infusion (5 min) and after ECT (0, 2.5, 5, 10, 15, 30 min). Continuous data were analysed using a Student’s t-test for two-group comparisons, a mixed model analysis of variance for group comparisons and various time point analyses. Categorical data were analysed using the Chi-square/Fisher’s exact test. Results: There were no differences between the groups regarding demographics. Myalgia and fasciculations were less in Group D than in Group C (P < 0.001). MBP and HR changes were comparable (P > 0.05). Conclusion: A low dose of dexmedetomidine (0.25 µg/kg) effectively reduces myalgia and fasciculations due to succinylcholine in patients undergoing electroconvulsive therapy.

Background and Aim: Electroconvulsive therapy (ECT) is an effective intervention for psychiatric patients. Succinylcholine is considered the drug of choice for muscle relaxation for ECT. Significant adverse effects of succinylcholine include fasciculation and myalgia. Dexmedetomidine is a highly selective a-2 adrenergic agonist. This study aims to determine the efficacy of a low dose of dexmedetomidine in reducing succinylcholine-induced myalgia in patients receiving ECT. Methods: This randomised controlled trial was conducted on 100 patients, aged 18-65 years, undergoing ECT, who were randomly allocated into two groups with an allocation ratio of 1:1. Group D received intravenous (IV) dexmedetomidine 0.25 µg/kg, and Group C received IV normal saline (0.9%). Patients' self-reported myalgia scores were measured after 60 min of the procedure. Fasciculations were noted after IV succinylcholine administration. Heart rate (HR) and mean blood pressure (MBP) were measured at baseline, after infusion (5 min) and after ECT (0, 2.5, 5, 10, 15, 30 min). Continuous data were analysed using a Student's t-test for two-group comparisons, a mixed model analysis of variance for group comparisons and various time point analyses. Categorical data were analysed using the Chi-square/Fisher's exact test. Results: There were no differences between the groups regarding demographics. Myalgia and fasciculations were less in Group D than in Group C (P < 0.001). MBP and HR changes were comparable (P > 0.05). Conclusion: A low dose of dexmedetomidine (0.25 µg/kg) effectively reduces myalgia and fasciculations due to succinylcholine in patients undergoing electroconvulsive therapy. [ABSTRACT FROM AUTHOR]

Rapid sequence intubation (RSI) is frequently performed by emergency medical services (EMS). We investigated the relationship between succinylcholine and rocuronium use and time until first laryngoscopy attempt, first-pass success, and Cormack-Lehane (CL) grades. We included adult patients for whom prehospital RSI was attempted from July 2015 through June 2022 in a retrospective, observational study with pre-post analysis. Timing was verified using recorded defibrillator audio in addition to review of continuous ECG, pulse oximetry, and end-tidal carbon dioxide waveforms. Our primary exposure was neuromuscular blocking agent (NMBA) used, either rocuronium or succinylcholine. Our prespecified primary outcome was the first attempt Cormack-Lehane view. Key secondary outcomes were first laryngoscopy attempt success rate, timing from NMBA administration to first attempt, number of attempts, and hypoxemic events. Of 5,179 patients in the EMS airway registry, 1,475 adults received an NMBA while not in cardiac arrest. Cormack-Lehane grades for succinylcholine and rocuronium were similar: grade I (64%, 59% [95% CI 0.64–1.09]), grade II (16%, 21%), grade III (18%, 16%), grade IV (3%, 3%). The median interval from NMBA administration to start of the first attempt was 57 s for succinylcholine and 83 s for rocuronium (mean difference 28 [95% CI 20–36] seconds). First attempt success was 84% for succinylcholine and 83% for rocuronium. Hypoxemic events were present in 25% of succinylcholine cases and 23% of rocuronium cases. Prehospital use of either rocuronium or succinylcholine is associated with similar Cormack-Lehane grades, first-pass success rates, and rates of peri-intubation hypoxemia. [ABSTRACT FROM AUTHOR]

This study investigated whether abnormal peak inversion spontaneous potentials (PISPs) recorded at resting myofascial trigger points (MTrPs) stem from the discharge of muscle spindles. Forty-eight male Sprague-Dawley rats were randomly divided into six groups. Five groups underwent MTrP modeling intervention, whereas one group did not receive intervention and was duly designated as the blank control. After model construction, five rat models were randomly subjected to ramp-and-hold stretch tests, succinylcholine injection, eperisone hydrochloride injection, saline injection, and blank drug intervention. By contrast, the rats in the blank control group were subjected to ramp-and-hold stretch tests as a control. Frequencies and amplitudes of PISPs were recorded pre- and post-interventions and compared with those of the blank group. Stretch tests showed that the depolarization time and amplitude of PISPs ranged from 0.4 ms to 0.9 ms and from 80 uV to 140 μV, respectively. However, no PISPs were observed in the control rats. The frequency of PISPs in the ramp and hold phases and the first second after the hold phase was higher than that before stretching (p < 0.01). Succinylcholine and eperisone exerted excitatory and inhibitory effects on PISPs, respectively. In the group injected with 0.9% saline, no considerable differences of the PISPs were observed during the entire observation period. In conclusion, PISPs recorded at resting MTrPs are closely related to muscle spindles. The formation of MTrPs may be an important factor that regulate dysfunctional muscle spindles. [ABSTRACT FROM AUTHOR]

Administration of succinylcholine to patients with a variant in the butyrylcholinesterase (BChE) gene increases the risk of anesthesia emergence prior to recovery from neuromuscular blockade (NMB). Application of quantitative neuromuscular monitoring (NMM) can identify residual NMB. We present two patients with abnormal BChE gene variants. In the first case, quantitative monitoring was applied too late to prevent awareness, but allowed diagnosis and prevented admission to the intensive care unit. In the second case, monitoring was applied prior to NMB, which enabled early diagnosis and prevented premature awakening from anesthesia. These cases illustrate the importance of quantitative NMM, even in short cases and with short-acting depolarizing agents such as succinylcholine. The clinical implications of this report include a more consistent use of NMM to identify and manage patients with undiagnosed abnormal BChE and to prevent premature anesthesia emergence. [ABSTRACT FROM AUTHOR]

Pediatric difficult airway management is more challenging for an anesthesiologist due to anatomical and physiological differences as compared to adults. Moreover, the familiarity with the use of difficult airway equipment in adults does not equate to proficiency for the same in children. So, here we are presenting the management of a unique case of a difficult airway due to postburn neck contracture in a 4-year-old child, which was managed successfully with the help of a video laryngoscope after the failure attempt with a flexible fiberoptic bronchoscope. [ABSTRACT FROM AUTHOR]

INTRODUCTION The goal of rapid sequence intubation is to secure the patients airway smoothly and quickly, minimizing the chances of regurgitation and aspiration of gastric contents. Traditionally succinylcholine chloride has been the neuromuscular blocking drug of choice for use in rapid sequence intubation because of its rapid onset of action and profound relaxation. Succinylcholine chloride remains unsurpassed in providing ideal intubating conditions. However the use of succinylcholine chloride is associated with many side effects like muscle pain, bradycardia, hyperkalaemia and rise in intragastric and intraocular pressure. Rocuronium bromide is the only drug currently available which has the rapidity of onset of action like succinylcholine chloride. Hence the present study was undertaken to compare rocuronium bromide with succinylcholine chloride for use during rapid sequence intubation in adult patients METHODOLOGY The study population consisted of 90 patients aged between 18-60 years posted for various elective surgeries requiring general anaesthesia at Sri Venkateswara Medical College, Tirupati study population was randomly divided into 2 groups with 30 patients in each sub group. 1. Group I: Intubated with succinylcholine chloride 1 mg kg-1 (n = 30) 2. Group II: Intubated with rocuronium bromide 0.9 mg kg-1 (n = 30) Intubating conditions were assessed at 60 seconds based on the scale adopted by Toni Magorian et al. 1993. The haemodynamic parameters in the present study were compared using p-value obtained from student t-test. RESULTS It was noted that succinylcholine chloride 1 mg kg-1 body weight produced excellent intubating conditions in all patients. Rocuronium bromide 0.9 mg kg-1 body weight produced excellent intubating conditions in 96.67% of patients, which was comparable to that of succinylcholine chloride. INTERPETATION AND CONCLUSION Thus, from the present study, it is clear that succinylcholine chloride is the drug of choice for rapid sequence intubation. Rocuronium bromide is a safe alternative to succinylcholine chloride in conditions where succinylcholine chloride is contraindicated and in whom there no anticipated difficult airway. [ABSTRACT FROM AUTHOR]

Background: Rocuronium bromide is a new amino steroidal neuromuscular blocking agent which is structurally related to vecuronium and its onset time and intubating conditions are comparable with succinylcholine and without the undesirable side effects. Aims and Objectives: This study was planned to evaluate the ideal intubating dose of rocuronium bromide by comparing intubating conditions achieved by its different doses of rocuronium bromide and to consider rocuronium as an ideal intubating muscle relaxing agent, in place of succinylcholine chloride for elective long surgeries. Materials and Methods: This study was conducted on 120 patients who fulfilled the eligibility criteria. These patients were randomized into four groups of 30 each by block randomization technique. Each group received rocuronium bromide 0.6 mg/kg, 0.9 mg/kg, 1.2 mg/kg, and succinylcholine chloride 1 mg/kg, respectively. Results: Out of all the three doses of rocuronium bromide 0.9 mg/kg produced a similar intubating condition as succinylcholine chloride in the dose of 1 mg/kg without undue prolongation of the neuromuscular blockade. Conclusion: Rocuronium bromide can be used as an alternative to succinylcholine as an ideal intubating muscle relaxing agent. [ABSTRACT FROM AUTHOR]

Introduction and purpose Muscle relaxants have been integral to medical practice for decades, benefiting both anesthesiologists for smooth patient intubation and surgeons requiring deep muscle relaxation. This article focuses on succinylcholine, a prominent muscle relaxant, exploring its historical context, efficacy, and the accumulated data on potential life-threatening side effects. The manuscript analyzes the available knowledge regarding the adverse effects of succinylcholine in clinical practice, presenting literature-identified methods aimed at risk mitigation. Summarizing the current understanding of succinylcholine's risks seeks to enhance its effective use, decrease adverse incidents in patients, and contribute to the overall safety of both patients and healthcare providers. Material and methods The following review of studies was based on articles obtained from the PubMed and Google Scholar databases. Key search terms included suxamethonium, succinylcholine, suxamethonium hyperkalemia, suxamethonium myalgia, suxamethonium anaphylaxis, suxamethonium cholinesterase deficiency, and suxamethonium malignant hyperthermia. Conclusions Suxamethonium's adverse effects range from muscle pain-related discomfort to rare, potentially lethal multi-organ complications, impacting patients' health diversely. Despite its drawbacks, succinylcholine remains crucial in anesthesiology. Ongoing research offers avenues to counteract or mitigate side effects. However, these methods necessitate further research to develop universal, widely available protocols in clinical settings. [ABSTRACT FROM AUTHOR]

Objectives: To compare the quality of intubating conditions and hemodynamic responses to the administration of Rocuronium Bromide and Succinyl Choline during general anesthesia. Methods: This was a comparative study conducted at the anesthesiology department of a tertiary care medical college. Sixty patients undergoing various surgeries under general anesthesia were included in this study based on predefined inclusion and exclusion criteria. Patients were divided into Group S (receiving succinylcholine) and Group R (receiving rocuronium). In all patients, the quality of intubating conditions was assessed. Excellent or good conditions were considered to be acceptable intubating conditions, whereas fair and poor conditions were considered unacceptable. Results: Mean age, weight, gender distribution, and ASA grades were comparable in both groups. The overall quality of intubation was found to be better in group S than in group R, and the difference was statistically significant (P=0.004). The duration of action was significantly longer in group R than in group S (P

Introduction and purpose Muscle relaxants have been integral to medical practice for decades, benefiting both anesthesiologists for smooth patient intubation and surgeons requiring deep muscle relaxation. This article focuses on succinylcholine, a prominent muscle relaxant, exploring its historical context, efficacy, and the accumulated data on potential life-threatening side effects. The manuscript analyzes the available knowledge regarding the adverse effects of succinylcholine in clinical practice, presenting literature-identified methods aimed at risk mitigation. Summarizing the current understanding of succinylcholine's risks seeks to enhance its effective use, decrease adverse incidents in patients, and contribute to the overall safety of both patients and healthcare providers. Material and methods The following review of studies was based on articles obtained from the PubMed and Google Scholar databases. Key search terms included suxamethonium, succinylcholine, suxamethonium hyperkalemia, suxamethonium myalgia, suxamethonium anaphylaxis, suxamethonium cholinesterase deficiency, and suxamethonium malignant hyperthermia. Conclusions Suxamethonium's adverse effects range from muscle pain-related discomfort to rare, potentially lethal multi-organ complications, impacting patients' health diversely. Despite its drawbacks, succinylcholine remains crucial in anesthesiology. Ongoing research offers avenues to counteract or mitigate side effects. However, these methods necessitate further research to develop universal, widely available protocols in clinical settings.

Background: One of the most important preconditions for any anesthetic operation is perioperative hemodynamic stability during laryngoscopy and intubation, which has been the subject of extensive research and documentation. Numerous approaches have been proposed to protect the patient from the sympathetic reaction, intraocular pressure (IOP) response, and catecholamine response during laryngoscopy and intubation. Aims and Objectives: To study the efficacy of two doses of intravenous dexmedetomidine premedication given as a single bolus dose over 10 min, 0.4 µg/kg and 0.6 µg/kg, 10 min before induction in preventing the rise of intraocular pressure following succinylcholine administration and endotracheal intubation. Materials and Methods: A retrospective randomized study was conducted. Ethical committee permission and signed informed consent were obtained from 60 eligible patients before the trial began. Results: Premedication with either 0.4 mcg/kg I.V. or 0.6 mcg/kg I.V. of dexmedetomidine diluted in normal saline at a 2 mcg/mL concentration administered over 10 min before induction resulted in significant obtundation of the rise in IOP associated with succinylcholine administration and intubation. Sympathetic response to laryngoscopy and intubation was also significantly diminished. The dose of 0.4 mcg/kg I.V. produced the best hemodynamic stability. Conclusion: Therefore, from the above research it can be concluded that, before succinylcholine delivery and intubation, dexmedetomidine 0.4 mcg/kg I.V. can be used as a premedication in situations where an increase in IOP could be hazardous. [ABSTRACT FROM AUTHOR]

Background: When used in cases with penetrating eye injuries, succinylcholine can lead to the disastrous complication of vision loss by increasing intraocular pressure and increasing the risk of globe rupture. The goal of this research was to determine if pre-treatment with intravenous dexmedetomidine could mitigate the effects of succinylcholine and intubation on intraocular pressure. Methods: The study was prospective and randomized. After discussing the technique in detail, the study was done on 50 eligible patients with the agreement of an ethical committee and the patients' signed informed consent. Research for this study was carried out at Lifecare Hospital, Baniyas, Abu Dhabi between January 2016 to December 2017. Results: The intraocular pressure of the study group decreased after receiving premedication. After succinylcholine and intubation, IOP rose in all three groups, but in the study groups, it never went beyond pre-treatment levels. The sympathetic response to laryngoscopy and intubation was successfully suppressed at both doses of dexmedetomidine, but hemodynamic stability was better at 0.4 mcg/kg than at 0.6mcg/kg. Conclusion: When it comes to preventing an increase in intraocular pressure (IOP) and dampening the sympathetic response, both dosages of dexmedetomidine i.e. 0.4 mcg/kg and 0.6 mcg/kg are equally effective. Nevertheless, the dose of 0.4 mcg/kg is associated with greater hemodynamic stability. Hence, preventing an increase in intraocular pressure with dexmedetomidine 0.4 mcg/kg may be useful. [ABSTRACT FROM AUTHOR]

RATIONALE: Controversies and practice variations exist related to the pharmacologic and nonpharmacologic management of the airway during rapid sequence intubation (RSI). OBJECTIVES: To develop evidence-based recommendations on pharmacologic and nonpharmacologic topics related to RSI. DESIGN: A guideline panel of 20 Society of Critical Care Medicine members with experience with RSI and emergency airway management met virtually at least monthly from the panel's inception in 2018 through 2020 and face-to-face at the 2020 Critical Care Congress. The guideline panel included pharmacists, physicians, a nurse practitioner, and a respiratory therapist with experience in emergency medicine, critical care medicine, anesthesiology, and prehospital medicine; consultation with a methodologist and librarian was available. A formal conflict of interest policy was followed and enforced throughout the guidelines-development process. METHODS: Panelists created Population, Intervention, Comparison, and Outcome (PICO) questions and voted to select the most clinically relevant questions for inclusion in the guideline. Each question was assigned to a pair of panelists, who refined the PICO wording and reviewed the best available evidence using predetermined search terms. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used throughout and recommendations of "strong" or "conditional" were made for each PICO question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and best practice statements, when the benefits of the intervention outweighed the risks, but direct evidence to support the intervention did not exist. RESULTS: From the original 35 proposed PICO questions, 10 were selected. The RSI guideline panel issued one recommendation (strong, low-quality evidence), seven suggestions (all conditional recommendations with moderate-, low-, or very low-quality evidence), and two best practice statements. The panel made two suggestions for a single PICO question and did not make any suggestions for one PICO question due to lack of evidence. CONCLUSIONS: Using GRADE principles, the interdisciplinary panel found substantial agreement with respect to the evidence supporting recommendations for RSI. The panel also identified literature gaps that might be addressed by future research. [ABSTRACT FROM AUTHOR]

Background: Pyloric distensibility has been reported as a predictive measure in gastroparesis. Measures can be obtained either during endoscopy under anesthesia or in unsedated patients. However, the impact of anesthetic drugs on the results of pyloric characteristics remains unknown. The objective of the present study was to determine the impact of anesthetics on pyloric characteristics measured using EndoFLIP® in patients with gastroparesis. Methods: Consecutive patients with gastroparesis from three French tertiary centers were retrospectively analyzed. Patients with a previous history of pyloric intervention were not considered for analysis. Medical records were reviewed for the potential use of anesthetic drugs during EndoFLIP® measurement. Key Results: One hundred twenty‐five patients were included in the present study [median age: 55.0 years (43.0–66.0)]. Thirty‐four patients (27.2%) had pyloric assessment without general anesthesia and 91 patients (72.8%) with general anesthesia. Pyloric pressure at 40 mL of distension was higher in patients with general anesthesia in comparison with patients without general anesthesia [18.7 (13.0–25.6) mmHg vs. 15.4 (11.9–20.7) mmHg; p = 0.044)]. In multivariate analysis, suxamethonium chloride administration was associated with decreased pyloric distensibility (OR: 3.9; 95% CI: 1.3–11.4; p = 0.013) while ephedrine was rather associated with increased pyloric distensibility (OR: 0.3; 95% CI: 0.1–0.9; p = 0.036). Conclusions and Inferences: This study is the first to have found an impact of general anesthesia on pyloric measurement using the EndoFLIP®. Therefore, further studies are needed to confirm these findings, if possible, prospective studies. [ABSTRACT FROM AUTHOR]

Samuel Debas Bayable,1 Netsanet Temesgen Ayenew,1 Abebaw Misganaw,1 Melaku Bantie Fetene,2 Wubet Dessie Amberbir3 1Department of Anesthesia, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia; 2Department of Anesthesia, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia; 3Department of Anesthesia, Menelik II Health Science College, Addis Ababa, EthiopiaCorrespondence: Samuel Debas Bayable, Tel +251 911437507, Email Samuel_debas@dmu.edu.et; samueldebas88@yahoo.comBackground: The incidence and severity of succinylcholine-induced fasciculation and postoperative myalgia have been shown to decrease when vecuronium bromide or preservative-free 2% plain lignocaine hydrochloride is administered before induction. The aim of this study is to examine the effectiveness of defasciculation dosages of vecuronium bromide and 2% preservative-free plain lignocaine hydrochloride in decreasing succinylcholine-induced fasciculation and postoperative myalgia in patients undergoing elective surgery.Methods: A total of 110 participants were included in a prospective observational cohort study that was located in an institution. Patients were randomly assigned to (Group L) and (Group V) based on the prophylactic measures they received from the responsible anesthetist utilizing preservative-free 2% plain lignocaine and defasciculation dose of vecuronium bromide, respectively. We recorded, socio-demographic variables, fasciculation, postoperative myalgia, total number of analgesics administered following surgery in 48hrs, and kind of procedure. The descriptive data were compiled using descriptive statistics. Categorical and continuous data were evaluated, respectively, using chi-square statistics and the independent sample t-test. To compare the prevalence of fasciculation and myalgia across the various groups, the Fischer exact test was performed. A 0.05 p-value was deemed statistically significant.Results: This study found that the incidence of fasciculation in the groups receiving the defasciculation doses of vecuronium bromide and preservative-free 2% plain lignocaine hydrochloride was 14.6% and 20% (p-value 0.007), respectively. The rate of mild-to-moderate postoperative myalgia in the vecuronium bromide group was 23.7%, 30.9%, and 16.4% in the first, 24th, and 48th hours, respectively (p-value 0.001), as opposed to 0%, 37.3%, and 9.1%, respectively (p-value 0.008) in the group receiving preservative-free 2% plain lignocaine hydrochloride.Conclusion: Pretreatment with 2% plain lignocaine that is preservative-free is more efficient than vecuronium bromide at reducing the frequency and intensity of postoperative succinylcholine-induced myalgia, whereas defasciculation dose of vecuronium was more effective prevention of succinylcholine-induced fasciculation.Keywords: fasciculation, muscle pain, postoperative myalgia, succinylcholine, vecuronium

The objective – to summarize the current literature data on the etiology, pathogenesis, diagnosis and treatment of malignant hyperthermia. The search and analysis of literature data on malignant hyperthermia in the medical information systems PubMed, Сochrane librarу, Cyberleninka for the last 10 years was performed with using the keywords: «malignant hyperthermia», «dantrolene», «general anesthesia», «succinylcholine», «inhalation anesthetics». The search criteria were met by 96 publications. In addition, references to selected articles were manually checked for applicable articles including recent reports of malignant hyperthermia, in addition to works of historical significance. It was shown that malignant hyperthermia develops in susceptible individuals during or after general anesthesia with the use of trigger agents – inhaled halogen-containing anesthetics and succinylcholine. Until recently, the problem of treatment in Russia remained unresolved, since specific therapy for this syndrome was not available. In connection with the official registration of Dantrolene in the Russian Federation, this problem no longer has a life-threatening potential. Doctors should recognize the symptoms of this disease as early as possible in order to quickly begin the pathogenetic treatment of malignant hyperthermia in order to prevent fatal complications. The material is intended for a wide audience of anesthesiologists, resuscitators and surgeons who may encounter this pathology in clinical practice.

The safe anesthesiological care of patients with neuromuscular diseases poses a particular challenge for anesthetists. Only a small group of muscle diseases and syndromes are associated with an increased risk of malignant hyperthermia and therefore require trigger-free anesthetic procedures avoiding volatile anesthetics and succinylcholine. These diseases are frequently associated with mutations in the RYR1, CACNA1S or STAC-3 genes. In other neuromuscular diseases, anesthetic-induced rhabdomyolysis can occur. Therefore, volatile anesthetics should be avoided in these patients in addition to the contraindication for succinylcholine. In other neuromuscular diseases the risk of a propofol infusion syndrome or myotonic crises can be elevated or the duration of the effect of non-depolarizing muscle relaxants can be changed in an incalculable way. In every case an individual anesthetic aproach including the avoidance of potential pharmacological or non-pharmacological triggers is essential for the safety of the patients. [ABSTRACT FROM AUTHOR]

Abstract Background Anesthesia-associated rhabdomyolysis is a rare complication of surgery that causes postoperative myalgia, weakness, and potential renal failure if not managed promptly. Predisposing conditions that may lead to this complication include muscular dystrophies and myopathies. Case presentation This rare case describes a pediatric non-Indigenous Australian patient developing this complication, with no known predisposing risk factors, and no clear etiology. A 9-year-old child with a background of asthma underwent an elective removal of keloid scar on her chest wall. The procedure was brief and uncomplicated, with an uneventful induction of anesthesia. During the emergence period, she developed acutely raised airway pressures with bronchospasm and laryngospasm requiring the use of salbutamol and suxamethonium with good effect. In the initial postoperative period, the patient complained of generalized myalgia and muscle weakness and was unable to mobilize independently. There was transient recovery to normal function; however, a recurrence of symptoms the following day with associated myalgias warranted admission to hospital. She was found to have rhabdomyolysis that was managed conservatively with a full recovery of several weeks. She was thoroughly investigated for any underlying cause, including genetic testing for malignant hyperthermia susceptibility (she had a variant of unknown significance but was negative for the known genetic abnormalities that cause malignant hyperthermia). Conclusion This case report demonstrates the importance of considering anesthesia-associated rhabdomyolysis as a differential for acute postoperative weakness, and outlines an investigative approach. To the best of our knowledge, it is the first case described in the pediatric literature to report biphasic progression of symptoms.

Introduction: Succinylcholine is a muscle relaxant of choice for paediatric intubation due to its fast onset and ultrashort duration of action but it is associated with unwanted sideeffects. Rocuronium bromide can be used alternatively to avoid those unwanted side-effects because of its fast onset and intermediate duration of action. Aim: To compare two doses of rocuronium bromide with succinylcholine in terms of intubating conditions, duration of action, haemodynamic variations, and complications to get a better alternative dose of rocuronium bromide in children undergoing elective surgeries. Materials and Methods: The present randomised, doubleblinded clinical trial study was conducted in the Department of Anaesthesiology, Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India from January 2021 to October 2022. Ninety American Society of Anaesthesiology (ASA) Grade-I-II children of both sexes of 1-10 years age, undergoing elective surgery were equally divided into three groups. Group-R9 (n=30) and Group-R12 (n=30) received rocuronium bromide 0.9 mg/kg and 1.2 mg/kg, respectively while Group-S (n=30) received succinylcholine 1.5 mg/kg. Comparative evaluation of intubating conditions was done around 60 seconds in all three groups and duration of action, haemodynamic variations, and complications were noted. All data were entered in a microsoft excel sheet and results were expressed as percentages, mean Standard Deviation (SD), chi-square test, and Analysis of Variance (ANOVA) test where the difference was considered statistically significant if the p-value <0.05 by using the software Statistical Package for the Social Sciences version 11.0 (SPSS version 11.0). Results: Rocuronium bromide 1.2 mg/kg and succinylcholine 1.5 mg/kg provided excellent intubating conditions in 96.7% children and good intubating conditions in 3.3% children in both groups while rocuronium bromide 0.9 mg/kg provided excellent intubation conditions in 83.3% of children and good intubating conditions in 16.7% of children There was a significant difference present in intubation scores between three groups (p=0.01). The duration of action was longer with rocuronium bromide 1.2 mg/kg (38.93±4.323 min) as compared to rocuronium bromide 0.9 mg/kg (26.07±2.791 min) while it was shortest with succinylcholine 1.5 mg/kg (6.00±1.74 min). Adverse effects like fasciculations were only found in children (n=30) receiving succinylcholine (p=0.01) but not in rocuronium bromide groups. Conclusion: Rocuronium bromide 1.2 mg/kg gives the same intubating conditions as succinylcholine 1.5 mg/kg with good haemodynamic stability and no side-effects but the duration of action was longer with rocuronium bromide 1.2 mg/kg as compared to rocuronium bromide 0.9 mg/kg. So, to avoid unwanted sideeffects of succinylcholine in children, rocuronium bromide 1.2 mg/kg can be used as an alternative to succinylcholine 1.5 mg/kg in children undergoing elective surgeries where early return of spontaneous recovery is not needed. [ABSTRACT FROM AUTHOR]

Tracheal tumours are rare and often present as asthma or chronic obstructive airway disease. These tumours can cause partial or complete airway obstruction, especially after giving anaesthesia. Here, we present a case of tracheal tumour posted for bronchoscopic excision. These tumours present as a real challenge to anaesthesiologists as the airway is shared with the surgeons and maintaining a patent airway can be difficult. [ABSTRACT FROM AUTHOR]

Aim and Objective: The purpose of this study was to compare the duration of action of Rocuronium and Suxamethonium during elective thyroidectomy. Methodology : This double-blind experimental study included 60 patients ranging in age from 18 to 60 years old who underwent elective thyroidectomy under general anaesthesia after approval from the Institutional Ethics Committee and written patient consent Result: The Duration of action was comparable between the groups with statistically significant difference (p value is less than 0.05). For analysis of difference in duration of action "t" test was used. P value is less than 0.05, (p=0.000) indicating that highly significant difference between the groups in the duration of action. Conclusion: The study found that Rocuronium has a significantly longer duration of action than Suxamethonium. [ABSTRACT FROM AUTHOR]