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LETTER TO THE EDITOR

The Ideal Dose of Succinylcholine for Tracheal Intubation

Department of Anesthesiology and Pain Medicine; University of Texas M. D.; Houston, TX

In Response:

It is not clear to me what point Dr. Lu and colleagues are trying to make (1). The Phase II block seen with succinylcholine is not a dose-related phenomenon (2). The authors’ views about the inadequacy of succinylcholine doses <1.0 mg/kg are not substantiated by any data. On the contrary, the available evidence supports the efficacy of 0.6 mg/kg succinylcholine (3–5). Dr. Lu and colleagues state that "in our view, 1.0–1.5 mg/kg succinylcholine is ideal for intubation." If "ideal" means perfect intubating conditions, their statement is erroneous. The most important lesson of our study (6) is that no dose of succinylcholine can guarantee excellent conditions within 60 s more than 90% of the time. In the final analysis, the dose of succinylcholine should be individualized, according the clinical situation.

REFERENCES

1. Zhijun L, Ying W, Buwei Y. The ideal dose of succinylcholine for tracheal intubation. Anesth Analg 2006;103:1581.[Free Full Text]
2. Naguib M, Lien CA, Aker J, Eliazo R. Posttetanic potentiation and fade in the response to tetanic and train-of-four stimulation during succinylcholine-induced block. Anesth Analg 2004;98:1686–91.[Abstract/Free Full Text]
3. Naguib M, Samarkandi A, Riad W, Alharby SW. Optimal dose of succinylcholine revisited. Anesthesiology 2003;99:1045–9.[Web of Science][Medline]
4. El-Orbany MI, Joseph NJ, Salem MR, Klowden AJ. The neuromuscular effects and tracheal intubation conditions after small doses of succinylcholine. Anesth Analg 2004;98:1680–5.[Abstract/Free Full Text]
5. El-Orbany MI, Joseph NJ, Salem MR. Tracheal intubating conditions and apnoea time after small-dose succinylcholine are not modified by the choice of induction agent. Br J Anaesth 2005;95:710–14.[Abstract/Free Full Text]
6. 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]

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