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On the Dose of Succinylcholine Required for Excellent Intubating Conditions

Sosis, Mitchel B., MS, MD, PhD

Section Editor(s): Shafer, Steven L.

doi: 10.1213/01.ANE.0000227119.00592.84
Letters to the Editor: Letters & Announcements

Board Certified Anesthesiologist; Lafayette Hill, Pennsylvania;

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To the Editor:

Naguib et al. (1) examined the dose of succinylcholine required for excellent tracheal intubating conditions. The authors studied intubating conditions with succinylcholine doses of 0.0, 0.3, 0.5, 1.0, 1.5, and 2.0 mg/kg. They noted that in certain situations “…any intubating conditions short of excellent may not be suitable.”

Naguib et al. concluded, in part, that the incidence of excellent intubating conditions was significantly more frequent (P < 0.05) in patients who received 2.0 mg/kg succinylcholine than with 0.3 mg/kg of succinylcholine. In addition, they noted that “…increasing the dose of succinylcholine from 1.5 to 2.0 resulted in only 6.7% improvement in the incidence of excellent intubating conditions (from 80% to 86.7%).” Yet they reached the following conclusion: “It appears that there are no advantages to using doses of succinylcholine larger than 1.5 mg/kg.” The authors did not evaluate fasciculations, myalgias, muscle damage, or other factors that might warrant limiting the doses of succinylcholine in their study, nor did they discuss these issues.

I would like to ask the authors on what objective basis is 1.5 mg/kg of succinylcholine recommended over 2.0 mg/kg, because their data appear to support the larger dose.

Mitchel B. Sosis, MS, MD, PhD

Board Certified Anesthesiologist

Lafayette Hill, Pennsylvania

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1. Naguib M, Samarkandi A, Emad El-Din M, et al. The dose of succinylcholine for excellent intubating conditions. Anesth Analg 2006;102:151–5.
© 2006 International Anesthesia Research Society