Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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1 2 2 O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U LY 2 0 1 5 Should You Stock Succinylcholine or Rocuronium? Which should be your first choice for breaking a laryngospasm? O ne legacy of Joan Rivers's tragic death is that endoscopy centers throughout the country are supplementing their for- mularies with the depolarizing muscle relaxant succinyl- A N E S T H E S I A A L E R T Perry V. Ruspantine, CRNA, APRN Advantages Disadvantages Succinylcholine • When a laryngospasm can't be broken by chin lift, jaw thrust or positive pressure ventilation with 100% oxy- gen, succinylcholine is typical- ly administered in a dose of 0.25 to 1.0 mg/kg and usual- ly lets you easily intubate and ventilate the patient within 30 to 60 seconds. • It wears off quickly, usually letting patients return to spontaneous respirations in 5 minutes or less. • Malignant hyperthermia. It's rare, but for patients who've never had surgery, it's a real possibility. Stocking succinyl- choline adds several expenses to an endoscopy center, from the cost of dantrolene or a similar agent to training staff to respond in an MH emergency. • Bradycardia. Sometimes causes significant bradycardia, which must be followed with doses of atropine. • Pseudocholinesterase deficiency. As with MH, it's rare, but when it happens, a patient may require ventilator support for many hours. • Potassium elevation. Patients who already have elevated potassium can have significant cardiac issues. • It can increase intracranial pressure. • It can cause muscle soreness from fasciculation at the time of administration. • It can further dehydrate patients who are already dehydrated (which many colonoscopy patients are, due to the bowel prep). Rocuronium • In doses of 0.6 to 1.2 mg/kg, it's proven to be as effective in muscle relaxation and emergency intubation as succinylcholine. • If rocuronium is stocked, the only other medications needed are neostigmine and either robinul or atropine for reversal. • Other than causing a signifi- cant histamine release at large doses, there are no hid- den side effects. • Larger doses are needed to facilitate similar onset times to that of succinylcholine. • The clinical duration of action at larger doses is significantly longer than that of succinylcholine. However, once acceptable nerve stimulator responses are achieved, it can be reversed with neostigmine and either robinul or atropine. • Myasthenic patients require smaller doses.