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A Case of Frozen Succinylcholine Encountered During Emergency Cesarean Delivery

Stone, Julian, FRCA; Fawcett, William, FRCA

doi: 10.1097/00000539-200211000-00083
LETTERS TO THE EDITOR: Letters & Announcements
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Anesthetic Department

Royal Surrey County Hospital

Egerton Road

Guildford

Surrey, United Kingdom

To the Editor:

We would like to present a previously unreported complication encountered during an emergency Cesarean section for persistent fetal bradycardia in a primiparous woman (body weight: 110 kg). There was inadequate time to perform a regional procedure, so a general anesthetic was performed.

After breathing oxygen, the patient was given thiopental 500 mg IV; the succinylcholine could not be injected. Closer inspection revealed the contents to be completely frozen. A second succinylcholine was prepared and given with a delay of less than 1 minute. There was no evidence of airway soiling or recall.

Emergency anesthetic drugs are often prepared and stored in a refrigerator in the obstetric suite. Frozen thiopental has been reported (1), but is a less serious complication, because fresh drug can be prepared with the patient still conscious with minimal delay. Frozen succinylcholine is potentially more serious, however, because in the absence of muscular paralysis, instrumentation of the airway with a laryngoscope (or a laryngeal mask) after a sleep dose of thiopental would be difficult and dangerous. We were fortunate that a second dose of succinylcholine was readily available. If emergency drugs are to be stored in refrigerators, it should be away from the icebox.

Julian Stone, FRCA

William Fawcett, FRCA

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Reference

1. Emmons S, Abeyewardene L, Ramakrishnan U. Case of frozen thiopental. Anesth Analg 1998; 87: 748.
© 2002 International Anesthesia Research Society