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PEDIATRIC ANESTHESIA

The Potency of Succinylcholine in Obese Adolescents

John B. Rose, MD^*, Mary C. Theroux, MD, and Michael S. Katz, MD

*Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, and Department of Anesthesiology and Pediatrics, University of Pennsylvania, School of Medicine; and Department of Anesthesiology and Critical Care Medicine, Alfred I. duPont Hospital for Children, Wilmington, Delaware, and Department of Anesthesiology, Thomas Jefferson Medical College, Philadelphia, Pennsylvania

Address correspondence and reprint requests to Mary C. Theroux, MD, Department of Anesthesiology, Alfred I. duPont Hospital for Children, PO Box 269, Wilmington, DE 19899. Address e-mail to mtheroux{at}nemours.org

We constructed a single-dose response curve for succinylcholine in 30 obese adolescents during thiopental-fentanyl anesthesia administration by using 100 µg/kg, 150 µg/kg, or 250 µg/kg IV. The maximal response (percent depression of neuromuscular function) of the adductor pollicis to supramaximal train-of-four stimuli was recorded by using a Datex (Helsinki, Finland) relaxograph. Linear regression and inverse prediction were used to determine doses of succinylcholine to produce 50% (ED₅₀), 90% (ED₉₀), and 95% (ED₉₅) depression of neuromuscular function. The ED₅₀, ED₉₀, and ED₉₅ were 152.8 µg/kg (95% confidence interval: 77.8–299.5), 275.4 µg/kg (95% confidence interval: 142–545.7), and 344.3 µg/kg (95% confidence interval: 175.3–675.3), respectively. This ED₅₀ is similar to the dose reported for similarly aged, nonobese adolescents, 147 µg/kg. The previously reported ED₉₅ for succinylcholine in nonobese adolescents, 270 µg/kg, is within the 95% confidence interval generated for ED₉₅ in our study.

Implications: The potency estimates for succinylcholine in obese (body mass index > 30 kg/m²) adolescents are comparable to those in similarly aged nonobese adolescents when dosing is calculated based on total body mass and not lean body mass. When a rapid sequence induction of anesthesia is considered in an obese adolescent, the dose of succinylcholine should be based on actual (not lean) body mass.

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