Summary
Although the dose of succinylcholine is customarily based on body weight this can be taken only as a rough guide. In the early phase after intravenous injection succinylcholine is partly removed by breakdown through the action of cholinesterase and in part by redistribution into the lean body mass. Sixty-six patients were given doses of succinylcholine based on lean body mass. 0.8 mg/Kg LBM was found to be quite adequate for complete muscle relaxation, permitting easy and atraumatic endotracheal intubation in all cases. Lean body mass was a better guide to dosage than body weight.
Length of apnoea and duration of muscular paralysis were dose related; the bigger the dose the longer the response. However at 0.8 mg/Kg LBM they were better correlated with fat than with dose.
Obese people have a relatively shorter recovery time from apnoea and muscular paralysis.
Résumé
A poids égal, une personne maigre et une personne grasse ne demandent pas la même dose de succinylcholine; la personne grasse en demande moins. Si toutefois la dose est calculée ďaprès le poids du corps, elle est exagérée, surtout pour les personnes grasses. Mais si elle est calculée sur la base de la masse corporelle maigre (0.8 mg/kg MCM), on évite la dose excessive. Cette dose MCM est toujours suffisante pour produire 100 pour cent ďarrêt des contractions musculaires et pour amener des conditions idéales pour une intubation facile.
La durée ďapnée (moyenne de 5.9 minutes) après la succinylcholine est plus longue à la suite de grosses doses, mais moins longue chez les obèses. De même, le temps requis pour le retour à 100 pour cent des contractions musculaires (moyenne 9.2 minutes) est plus long à la suite de grosses doses, et moins long chez les obèses.
Article PDF
Similar content being viewed by others
References
Argent, D., Dinnick, O., &Hobbigeh, F. Prolonged apnoea after suxamethonium in man. Brit J. Anaesth.,27: 24 (1955).
Bourne, J., Collier, H., &Somers, G. Succinylcholine (succinoylcholine) muscle relaxant of short duration. Lancet,262: 1225 (1952).
Borders, R.W., Stephen, C.R., Nowill, W.K., &Martin, R. The interrelationship of cholinesterases during anesthesia. Anesthesiol.16: 401 (1955).
Baraka, A. Effect of halothane on tubocurarine and suxamethonium block in man. Brit. J. Anaesth.40: 602 (1968).
Callaway, S., Davies, D., &Rutland, J. Blood cholinesterase levels and range of personal variation in a healthy adult population. Brit. Med, J.,ii, 812 (1951).
Calvert, J., Lehmann, H., Silk, E., &Slack, W. Prolonged apnoea after suxamethonium. Lancet, Aug.21, 354 (1954).
Cohen, P., Reynolds, R., &Naidl, J. A simple test for pseudo-cholinesterase. Anesthesiol.32, 3, 281 (1970).
Dal Santo, G. Kinetics of distribution of radioactive labeled muscle relaxants III Investigations with 14 C-succinyldicholine and 14 C-succinylmonocholine during controlled conditions. Anesthesiol.29, 3, 435 (1968).
Doenicke, A., St. Schmidinger, &Khumey, I. Suxamethonium and serum cholinesterase. Brit. J. Anaesth.40: 834 (1968).
Eger, E.I. Respiratory and circulatory factors in uptake and distribution of volatile anaesthetic agents. Brit. J. Anaes.36: 155 (1964).
Evans, F., Gray, P., Lehmann, H., &Silk, E. Sensitivity to succinylcholine in relation to serum cholinesterase. Lancet, June21, 1229 (1952).
Evans, F., Gray, P., Lehmann, H., &Silk, E. Effect of pseudo-cholinesterase level on actions of succinylcholine in man. Brit. Med. J.i, 136 (1953).
Evans, F. &Lehmann, H. Prolonged apnoea after suxamethonium. Lancet, Sept.18, 601 (1954).
Foldes, F.F., Vandervort, R.S., &Shanor, S.P. The fate of succinylcholine in man. Anesthesiol.16, 1, 11–21 (1955).
Foldes, F.F. &Norton, S. The urinary excretion of succinyldicholine and succnylmonocholine in man. Brit. J. Pharmacol.9: 385 (1954).
Fohbat, A., Lehmann, H., &Silk, E. Prolonged apnoea following injection of succinyldicholine. Lancet, Nov.21, 1067 (1953).
Franks, E.H. Prolonged apnoea following suxamethonium. Lancet, Dec.26, 1210 (1953).
Gubner, R.S. Fatness, fat and coronary heart disease. Nutr. Rev.15: 353 (1957).
Gubner, R.S. Simple anthropometric indices of body fatness and heart size. Clin. Res.9: 15 (1961).
Hall, L., Lehmann, H., &Silk, E. Response in dogs to relaxants derived from succinic acid and choline. Brit. Med. J.,1: 134 (1953).
Habt, S.M. &Mitchell, J.V. Suxamethonium in the absence of pseudocholinesterase. Brit. J, Anaesth.,34: 207 (1962).
Hodges, R. Prolonged apnoea following succinyldicholine. Lancet, Dec.5, 1358 (1953).
Kalow, W. &Gunn, D.R. The relation between dose of succinylcholine and duration of apnoeain man. J. Pharm. & Exper, Therap.,120: 203 (1957).
Kalow, W. The distribution, destruction and elimination of muscle relaxants. Anesthesiol.20, 2, 505 (1959).
Kalow, W. Relaxants in: Uptake and Distribution of Anesthetic Agents, Ed. Papper, E.M. and Kite, R.J. New York; McGraw-Hill Co. pp. 302–309 (1963).
Katz, R. &Ryan, J. The neuromuscular effects of suxamethonium. Brit J. Anaesth.,41: 381 (1969).
Katz, R., Norman, J., Seed, R., &Conrad, L. A comparison of the effects of suxamethonium and tubocurarin in patients in London and New York. Brit. J. Anaesth.,41: 1041 (1969).
King, J. &Dixon, R. A further factor contributing to inherited suxamethonium sensitivity. Brit. J. Anaesth.,41: 1023 (1969).
Lee, J.A. &Atkinson, R.S. A Synopsis of Anesthesia, p. 468. Baltimore: The Williams and Wilkins Co. (1964).
Lehmann, H. &Ryan, F. The familial incidence of low pseudocholinesterase level. Lancet,2: 124 (1956).
Lehmann, H. &Liddell Human cholinesterase (pseudocholinesterase); genetic variants and their recognition. Brit. J. Anaesth.41: 235 (1969).
Mendel, B. &Rudney, H. Studies on Cholinesterase I Cholinesterase and pseudo-cholinesterase. Biochem. J.37, 1, 59–63 (1943).
Mayrhofeb, O.K. Self experiments with succinylcholine chloride. Brit. Med. J.i, 1334 (1952).
Richards, H. &Youngman, H. The ultra-short acting relaxants. Brit. Med. J.,i, 1334 (1952).
Salvadob, R.A. &Kuntzman, R. Cholinesterase of adipose tissue. J. Pharm. & Exper. Therap.,150, 1, 85 (1965).
Thesleff, S. The pharmacological properties of succinylcholine iodide. Acta. Physiol. Scand.26: 103 (1952a).
Thesleff, S. An investigation of muscle relaxing action of succinylcholine iodide in man. Acta. Physiol. Scand.25: 348 (1952b).
Vickers, M.D. The cholinesterases and their significance to the anaesthetist using muscle relaxants. Brit. J. Anaesth.35: 528 (1963).
Walts, L. &Dillon, J.B. Clinical studies on succinylcholine chloride. Anesthesiol.28, 2, 372 (1967).
Weisberg, H.F. Water, Electroylte and Acid-Base Balance, 2nd ed. Baltimore: Williams &Wilkins (1962).
Whittaker, M. &Wijesundra, S. Hydrolysis of succinyldicholine by cholinesterase. Biochem. J.52: 475–9 (1952).
Whittaker, M. Genetic aspects of succinylcholine sensitivity. Anesthesiol.32, 2, 143 (1970).
Wolfers, P. Sensitivity to succinylcholine chloride. Brit. Med. J.2: 778 (1952).
Wulfsohn, N.L. &Joshi, C.W. Thiopental dosage based on lean body mass. Brit. J. Anaesth.41: 516 (1969).
Wulfsohn, N.L. Halothane dosage based on lean body mass. Brit J. Anaesth,41: 522 (1969).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Wulfsohn, N.L. Succinylcholine dosage based on lean body mass. Canad. Anaesth. Soc. J. 19, 360–372 (1972). https://doi.org/10.1007/BF03005960
Issue Date:
DOI: https://doi.org/10.1007/BF03005960