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LETTER TO THE EDITOR

Succinylcholine as an Epidural Test Dose

Department of Anaesthesia, Wellington Hospital, New Zealand, neale.mushet{at}ccdhb.org.nz

To the Editor:

In a recent case report of inadvertent succinylcholine injection into the epidural space, Sofianou et al. (1) observed that "no data have been reported regarding epidural administration of succinylcholine through an epidural catheter in humans." This is not the case. Forty-three years ago, Hylton et al. (2) intentionally injected epidural succinylcholine in three patients as part of a study on the causes of epidural failure and methods of identifying epidural venous catheterization. These intrepid investigators concluded that "when venous catheterization is suspected, injection of a small (30–40 mg) dose of succinylcholine through the epidural catheter is recommended. This results in minimal changes in tidal volume when the catheter is well placed, while injection through an intravascularly placed catheter causes apnea within 15–45 s." Sofianou et al. were simply administering an epidural test dose, but just got the dose wrong!

Footnotes

Dr. Sofianou does not wish to respond.

REFERENCES

1. Sofianou A, Chatzieleftheriou A, Mavrommati P, Velmachou K. Accidental epidural administration of succinylcholine. Anesth Analg 2006;102:1139–40.[Abstract/Free Full Text]
2. Hylton RR, Eger EI II, Rovno SH. Intravascular placement of epidural catheters. Anesth Analg 1963;43:379–82.[Medline]

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