Anesthesia Flashcards
What is Succinylcholine? what is a common adverse effect in renal failure patients?
The most likely diagnosis in this patient is succinylcholine toxicity. Succinylcholine is a depolarizing paralytic agent that is degraded by the enzyme pseudocholinesterase. Pseudocholinesterase is synthesized in the liver. Metabolites include succinyl and choline, which are then excreted in the urine. In renal failure patients, hyperkalemia is a common occurrence, and succinylcholine results in an increase in serum potassium levels in normal subjects by 0.5 to 2 mEq/L. Given this fact, succinylcholine should not be used in this patient, as she already has an elevated potassium level, putting her at high risk for arrhythmias.
Other adverse effects of succinylcholine toxicity include malignant hyperthermia, muscle pains, acute rhabdomyolysis with hyperkalemia, transient ocular hypertension, constipation, and changes in cardiac rhythm, including bradycardia and cardiac arrest. In patients with neuromuscular disease or burns, a single injection of succinylcholine can lead to massive release of potassium from skeletal muscles, potentially resulting in cardiac arrest. Conditions having susceptibility to succinylcholine-induced hyperkalemia are burns, closed-head injury, acidosis, Guillain–Barré syndrome, cerebral stroke, drowning, severe intra-abdominal sepsis, massive trauma, myopathy, and tetanus. In addition, the additive/synergistic effects of succinylcholine and an opioid, sedative, or anesthetic agent can lead to succinylcholine toxicity. In rare cases, acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death have been reported in apparently healthy children and adolescents.
