Evidence Based Practice and Quality Assurance
Background and Goal of Study: Succinylcholine is often used for rapid sequence induction (1). Fasciculation and myalgia are frequent succinyl-choline-related adverse effects. The relative efficacy of pharmacological pretreatments to prevent these adverse effects remains unclear (2).
Materials and Methods: Extensive search for full reports of randomized trials (to 2.2004) that tested pretreatments vs. placebo for the prevention of succinylcholine-related fasciculation and myalgia. Dichotomous data on fasciculation, myalgia, and pretreatment-related adverse effects were combined using a fixed effect model.
Results and Discussions: 52 trials (5,318 patients) tested a large variety of pretreatments. In control groups, the average incidence of fasciculation was 95%, and of myalgia at 24 hours was 50%. No relationship between incidence of fasciculations and incidence of myalgia was found. Low-dose nondepolarizing myorelaxants, sodium-channel-blockers (lidocaine, phenytoin), and magnesium were most effective in preventing fasciculation (number-needed-to-treat, 1.5 to 2.5). Best prevention of myalgia after 24 hours was with low-dose rocuronium or gallamine and sodium-channel-blockers (number-needed-to-treat, 3), and with non-steroidal anti-inflammatory drugs (number-needed-to-treat, 2.5). With low-dose myorelaxants there was an increased incidence of blurred vision, weakness, and difficulty in swallowing and breathing.
Conclusion: Low-dose myorelaxants, magnesium and sodium channelblockers may be used to prevent succinylcholine-related fasciculation. Nonsteroidal anti-inflammatory drugs are most efficacious for the prevention of myalgia. With low-dose non-depolarizing myorelaxants, there is a finite risk of potentially serious paralyzing adverse effects.