Paralytic References ==================== Kovarik WD, Mayberg TS, Lam AM, Mathisen TL, Winn HR Succinylcholine does not change intracranial pressure, cerebral blood flow velocity, or the electroencephalogram in patients with neurologic injury. Anesth Analg, 78: 3, 1994 Mar, 469-73 The effect of succinylcholine (SCh) on intracranial pressure (ICP) was studied in 10 mechanically ventilated patients (Glasgow coma scale score 3-10, median 6) being treated for increased ICP in an intensive care unit. Mean arterial blood pressure (MAP), ICP, processed electroencephalogram (EEG), and mean middle cerebral artery blood flow velocity (V mca) were monitored. Baseline measurements after saline injection were obtained for 5 min. SCh (1 mg/kg) was administered intravenously and the above variables were monitored for 15 min. Neither saline nor SCh cause any significant change in cerebral perfusion pressure, MAP, V mca, EEG, or ICP. We conclude that in brain-injured patients, SCh did not alter cerebral blood flow velocity, cortical electrical activity, or ICP. Moreno RJ, Kloess P, Carlson DW Effect of succinylcholine on the intraocular contents of open globes Ophthalmology, 98: 5, 1991 May, 636-8 The use of succinylcholine in patients with suspected or proven open globes is considered dangerous by some for fear of extruding the intra-ocular contents as a consequence of the co-contraction of the extraocular muscles it produces. To test this hypothesis, the authors devised an anterior and a posterior trauma model in the cat eye. Thirty events were studied using the anterior trauma model and eight with the posterior model. The only observable effect of succinylcholine administration was forward displacement of the lens and iris. No intraocular content was lost in any event. The authors believe this study supports the argument that, when indicated, succinylcholine may be considered in open globes. Wang ML, Seiff SR, Drasner K A comparison of visual outcome in open-globe repair: succinylcholine with D-tubocurarine vs nondepolarizing agents. Ophthalmic Surg, 23: 11, 1992 Nov, 746-51 We compared the visual outcome in patients with ocular perforations who received succinylcholine with d-tubocurarine during anesthesia induction, with the visual outcome of those who did not. No statistically significant differences in visual outcome were detected. No extrusion of intraocular contents occurred during induction in either group. Suxamethonium and hyperkalaemia [see comments] Yentis SM Anaesth Intensive Care, 18: 1, 1990 Feb, 92-101 Severe life-threatening hyperkalaemia may occur following administration of suxamethonium during certain periods after burns, neurological injuries, and in certain other conditions. Although this response is well-known, there is disagreement about when it may occur. This review describes the normal hyperkalaemic response to suxamethonium, the factors affecting it, the conditions in which it may be exaggerated, and the periods of high risk. "From these studies and case reports, it can be concluded that an abnormal hyperkalemic response is unlikely before 14 days after burns, as it has been reported only once: at nine days. There is therefore no evidence to suggest avoidance of suxamethonium before at least seven days and even this value is based upon speculation that there would have been a lesser, but still dangerous, increase in potassium at, say, eight days. Excessive hyperkalemia has occurred up to 66 days after burns, but there are no reports of an abnormal response after this time. ... (i) burns; nine days until just over two months. (ii) upper motor neurone lesions, trauma and spinal cord lesions; ten days until six to seven months. (iii) peripheral denervation; four days until six to seven months. (iv) continuing processes, such as neuropathies, tetanus, infection; seem to present a continuing period of risk after about seven days."