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Anesth Analg 2006;103:1581
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000246431.57502.56

LETTER TO THE EDITOR

Editor-in-Chief Steven L. Shafer

The Ideal Dose of Succinylcholine for Tracheal Intubation

Zhijun Lu, MD, Ying Wang, MD, and Buwei Yu, MD

Department of Anesthesiology; Rui Jin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai, People’s Republic of China; lusamacn{at}yahoo.com

To the Editor:

We read with interest the recent article by Naguib et al. (1) in which they investigated different doses of succinylcholine for rapid-sequence induction of anesthesia. We agree with these authors that a dose of succinylcholine higher than 1.5 mg/kg is not necessary for tracheal intubation. A high dose of succinylcholine (2–5 mg/kg) may result in so-called "Phase II block," in which the characteristics of neuromuscular blockade resemble those of the nondepolarizing drugs, and the duration of blockade is considerably prolonged (2).

We also oppose the use of small-dose succinylcholine (<1.0 mg/kg) to facilitate intubation, although 0.5 mg/kg succinylcholine has been considered as an acceptable dose (3). In some unpredicted difficult situations, the incidence of failure may be increased with a small dose of succinylcholine (4). In our opinion, 1.0–1.5 mg/kg succinylcholine is the ideal dose for intubation in clinical anesthesia.

REFERENCES

  1. 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.[Abstract/Free Full Text]
  2. Orebaugh SL. Succinylcholine: adverse effect and alternatives in emergency medicine. Am J Emerg Med 1999;17:751–21.
  3. Naguib M, Samarkandi A, Riad W, et al. Optimal dose of succinylcholine revisited. Anesthesiology 2003;99:1045–9.[Web of Science][Medline]
  4. Lu Z, Yu B. Do we need a low dose of succinycholine to facilitate intubation in teaching hospitals? Anesthesiology 2004; 100:1626, 1627.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press