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On the Dose of Succinylcholine Required for Excellent Intubating Conditions

Naguib, Mohamed, MD

Section Editor(s): Shafer, Steven L.

doi: 10.1213/01.ANE.0000227130.59931.8A
Letters to the Editor: Letters & Announcements
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Department of Anesthesiology and Pain Medicine; University of Texas M.D. Anderson Cancer Center; Houston, Texas; naguib@mdanderson.org

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In Response:

Dr. Sosis (1) missed the point of our study. We (2) clearly stated that our objective was to define the dose of succinylcholine that provides excellent intubation conditions in 90% of the patients within 60 s during a simulated rapid-sequence induction of anesthesia. Because it was not our study's objective to evaluate fasciculations, myalgias, or muscle damage, we did not address these issues in our paper. Further, this information is readily available in the literature. For instance, Hochhalter (3) and Mingus et al. (4) evaluated the incidence of fasciculations and myalgias after 1.5 mg/kg succinylcholine.

Dr. Sosis' view that our data appear to support the 2.0 mg/kg over 1.5 mg/kg dose of succinylcholine is erroneous. The 6.7% improvement in the incidence of excellent intubating conditions after 2.0 mg/kg compared with 1.5 mg/kg dose of succinylcholine was not statistically significant. If the sample size were increased to 250 per group (rather than 30 per group) the 7% difference might be statistically significant. The most important lesson of our study is this: probably no dose of succinylcholine can guarantee >90% excellent conditions within 60 s.

Mohamed Naguib, MD

Department of Anesthesiology and Pain Medicine

University of Texas M.D. Anderson Cancer Center

Houston, Texas

naguib@mdanderson.org

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REFERENCES

1. Sosis MB. On the dose of succinylcholine required for excellent intubating conditions. Anesth Analg 2006;103:777–8.
2. Naguib M, Samarkandi AH, El-Din ME, et al. The dose of succinylcholine required for excellent endotracheal intubating conditions. Anesth Analg 2006;102:151–5.
3. Hochhalter CM. Evaluation of succinylcholine-induced fasciculations and myalgias with or without atracurium pretreatment. AANA J 1996;64:336–40.
4. Mingus ML, Herlich A, Eisenkraft JB. Attenuation of suxamethonium myalgias: effect of midazolam and vecuronium. Anaesthesia 1990;45:834–7.
© 2006 International Anesthesia Research Society