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ANESTHETIC PHARMACOLOGY

The Dose of Succinylcholine Required for Excellent Endotracheal Intubating Conditions

Department of Anesthesiology and Pain Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Departments of Anesthesia and Surgery, King Saud University, Riyadh, Saudi Arabia

Address correspondence and reprint requests to Mohamed Naguib, MB, BCh, MSc, MD, Department of Anesthesiology and Pain Medicine, The University of Texas M. D. Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 409, Houston, TX 77030–4009. Address e-mail to naguib{at}mdanderson.org.

In this prospective, randomized, double-blind, placebo-controlled study, we attempted to define the dose of succinylcholine that provides excellent intubation conditions in patients within 60 s during simulated rapid-sequence induction of anesthesia. Anesthesia was induced in 180 patients with 2 µg/kg fentanyl and 2 mg/kg propofol. After loss of consciousness, patients were randomly allocated to receive 0.3, 0.5, 1.0, 1.5, or 2.0 mg/kg succinylcholine or saline solution (control group). Tracheal intubation was performed 60 s later. A blinded investigator performed all laryngoscopies and graded intubating conditions. Intubating conditions were excellent in 0.0%, 43.3%, 60.0%, 63.3%, 80.0%, and 86.7% of patients after 0.0, 0.3, 0.5, 1.0, 1.5, and 2.0 mg/kg succinylcholine, respectively. The incidence of excellent intubating conditions was significantly more frequent (P < 0.001) in patients receiving succinylcholine than in the controls and in patients who received 2.0 mg/kg succinylcholine (P < 0.05) than in those who received 0.3 mg/kg succinylcholine. The calculated doses of succinylcholine (and their 95% confidence intervals) that are required to achieve excellent intubating conditions in 50% and 80% of patients at 60 s are 0.39 (0.29–0.51) mg/kg and 1.6 (1.2–2.0) mg/kg, respectively. It appears that there are no advantages to using doses of succinylcholine larger than 1.5 mg/kg.

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