Succinylcholine(SCh)-induced muscle fasciculations may be prevented by pretreatment with small doses of nondepolarizing muscle relaxants. The optimal timing of pretreatment to abolish fasciculation varies according to the drug used and dose. In this study, we determined the optimal timing of pretreatment of pancuronium to prevent muscular fasciculation in 100 patients. Each group (n=20) was received pancuronium 0.015 mg/kg at 1, 2, 3, 4, 5 minutes before SCh 3 mg/kg administration, respectively. The degree of fasciculations after SCh administration was observed and classified into one of 4 grade. There were significant differences between each groups (Ridit scores=10.078, p<0.01) To compare observed fasciculations of one grpup with those of the others, the degree of fasciculations was summed according to an arbitrary scale. The summation of grade in 4 minute group was lowest in this scale. It was concluded that the optimal timing of pretreatment, pancuronium 0.015 mg/kg, was 4 minutes before SCh 3 mg/kg injection.
Fasciculation* ; Humans ; Pancuronium* ; Succinylcholine*

BACKGROUND: Subparalyzing doses of nondepolarizing muscle relaxants are often given prior to succinylcholine to reduce the adverse effects of succinylcholine. We designed this study to determine the optimal choice of nondepolarizing muscle relaxants and the optimal interval between pretreatment and succinylcholine administration. METHODS: 240 ASA I or II adult patients were randomized into six groups: groups V1.5 and V3 received 0.015 mg/kg of vecuronium 1.5 min and 3 min before succinylcholine; group R1, R1.5, and R3 received 0.09 mg/kg of rocuronium 1 min, 1.5 min and 3 min before succinylcholine; and group SCC received no pretreatment. In this study, 2 mg/kg of succinylcholine was used. The presence and severity of fasciculations and intubating conditions were evaluated. Myalgia was also recorded on postoperative days 1 and 2. RESULTS: Group R3 was significantly better than other groups in terms of preventing fasciculations, and was followed by groups R1.5, R1, V3, V1.5 and group SCC. Intubating conditions were significantly worse in all pretreated groups than in group SCC, but no significant differences were observed between the pretreated groups. CONCLUSIONS: Succinylcholine-induced fasciculations are effectively prevented by pretreating with rocuronium 3 min or 1.5 min prior to succinylcholine administration. However intubating conditions are worsened by pretreatments.
Adult ; Fasciculation ; Humans ; Myalgia ; Succinylcholine* ; Vecuronium Bromide*

BACKGROUND: An experimental study was done to compare the efficacy of inside-out vein graft versus autogenous nerve graft as nerve conduit in promoting axonal regeneration in a rat model.

METHODS: The study used 16 Spraque-Dawley rats randomly divided into two groups: the inside-out vein graft group and control group (autognous nerve graft). The outcomes measured were histomorphology (axon number and diameter), muscle twitch response (amplitude) and the walking track analysis at 2, 4 6 and 8 weeks.

RESULTS: The inverted vein graft and control groups showed similar axon diameter (P=0.76), and axon number (P=0.85), weeks and similar muscle twitch responses (P=0.87) after eight weeks. The walking track analysis showed no significant difference between the two groups at eight weeks.

CONCLUSION: The study showed that the inside-out vein graft group had similar motor recovery as compared to control group based on the muscle twitch analysis and walking track analysis in a rat model.In terms of histomorphometric analysis, the two groups were similar in terms of axon diameter and axon count.

Plasma cholinesterase was assayed during the period immediately following IV bolus injection of succinylcholine 1mg/kg to test the effect of succinylcholine on pseudocholinesterase activity. Twenty healthy adult patients scheduled for elective surgery were studied. The resutls were as follows: The mean value of pre-injection pseudocholinesterase activity was 1124.15 IU/L, and the activity following succinylcholin injection was 1159.55IU/L during fasciculation, 982.70 at 1 min, 936.60 at 3 min, 891.25 at 5 min, 926.80 at 7 min, 1015.45 at 10 min, and 1007.70 at 15 min. It was concluded that the tendency to increase pseuducholinesterase activity during fasciculation seems to be due to choline, the metabolite of succinylcholine, however the cause of the significant decrease in pseudocholinesterase activity after fasciculation is uncertain. The only suggested mechanism is due to the inhibition of pseudocholinesterase by succinylcholine and its metabolites.
Adult ; Choline ; Cholinesterases ; Fasciculation ; Humans ; Plasma ; Pseudocholinesterase ; Succinylcholine*

Succinylcho1ine(Sch) may provoke regurgitation of gastric contents by producing fasciculations of abdominal musculatrue, which in turn may increase intragastric pressure. And it has been also believed that Sch increases intraocular pressure in part by contracture of the extraocular muscles. The purpose of this study was to determine whether these increases and the degree of fasciculation could be reduced by prior administration of a nondepolarizing muscle relaxant. Simultaneous administration of pancuronium or vecuronium with Sch significantly reduced the degree of fasciculation and also decreased the elevation of the intragastric pressure, but did not show any remarkable effect on the intraocular pressure, We might say that wed better use the small amount of nondepolarizing muscle relaxant with Sch to prevent the increase of intragastric pressure, thereby decrease the chance of regurgitation and aspiration during induction period.
Contracture ; Fasciculation ; Intraocular Pressure* ; Muscles ; Pancuronium ; Succinylcholine* ; Vecuronium Bromide

For the assessment the effect of succinylcholine (SCh) on pipecuronium, 52 adult patients undergoing elective surgery under general anesthesia were subjected to this study in which the EMG response (twitch height of the hand to TOF stimulation with 2Hz) of ulnar nerve was monitored and recorded with Datex Relaxograph. According to the amount and mode of the drugs administered, the patients were divided into four experimental groups: 1) Group I: a bolus injection of pipecuronium in dose of 0.05 mg/kg. 2) Group II: pipecuronium 0.1 mg/kg, a double dose of group l. 3) Group IU: pipecuronium 0.05 mg/kg given when the depressed twitch height by SCh (1 mg/kg) recovered to 25%6 of initial twitch height. 4) Group IV: mixed injection of SCh (1 mg/kg) and pipecumnium (0.05 mg/kg). The results were as follows ; 1) Mean onset time of pipecuronium was 6.5+/-0.5 minutes in group I and 4.1+/-0.5 minutes in group II, the latter being significantly shorter than group I (p<0.01). In group Ill, it was 2.1+/-0.23 minutes being significantly shorter than group I, II (p<0.001). In group IV it was 1.1+/-0.1 minutes which was more significantly shorter than group I, II, and IU. 2) Mean action duration of pipecuronium was 50.9+/-6.7 minutes in group I and 141.9+/-15.4 minutes in group II, the latter being longer significantly (p<0.001). In group IIl, it was 53.9+/-5.2 minutes which was similar to group I, but it was 69.8+/-6.5 minutes in group IV, being significantly longer than those of group I and III (p<0.05). 3) Mean potency of pipecuronium expressed by the percentage change of initial twitch height was 7.6+/-1.9% in group I, but it was significantly decreased to 4.2+/-0.9% in group II (p<0.05). In group III, it was 0.2+/-0.1% being sinificantly decreased than group I, II (p<0.001). In group IV, it was 0.0+0.0% being more significantly decreased than other groups (p<0.001). 4) Presence of pipecuronium in group IV did not affect on the intensity of fasciculation induced by SCh. These results indicate that succinylcholine may potentiate the pipecuronium based on the findings that succinylcholine increased the potency and lengthened the duration of action of pipecuronium.
Adult ; Anesthesia, General ; Fasciculation ; Hand ; Humans ; Pipecuronium* ; Succinylcholine* ; Ulnar Nerve

Muscle pain following succinylcholine chloride(SCC) is well documented, as are elevated serum potassium and increased creatine phosphokinase(CPK) levels. Pretreatment with a subparylsing dose of a non-depolarizing muscle relaxant before SCC is standard and accepted clinical practice in prevention of SCC induced fasciculation and associated sequlae but pretreatment redners the end-plate less sensitive to SCC: hence larger doses of SCC: hence larger doses of SCC are necessary to ensure adequate degree of relaxation. Recontly fahmy et al showed in a study that small doses of diazepam suppressed the fasciculation as well as the increase in serum potassium and creatine phosphokinase(CPK). Our study was undertaken to evaluate the effect of pretreatment with diazepam on the potential side effects of SCC. Eight cases were studied in four different groups. In the first group(control group): no diazepam was used, secoun group: with diazepam 0.05mg/kg, third group:: with diazepam 0.1mg/kg, grouth group: with diazepam 0.2mg/kg. As a result of this study, we can summarize as follows: 1) Diazepam pretreatment groups had no significant change in the prevention of muscle fasciculation following SCC than control groups. 2) Conditions for intubation were assessed as excellent to good in diazepam pretreatment and control groups. 3) The increase in serum potassium and CPK produced by SCC was not inhibited by diazepam pretreatment. 4) In the prevention of incidence of muscle pain, there were no significant difference between the control and diazepam pretreatment groups.
Creatine ; Diazepam* ; Fasciculation ; Incidence ; Intubation ; Myalgia ; Potassium ; Relaxation ; Succinylcholine

Subparalyzing dose of nodepolarizing relaxants prior to injection of succinylcholine has been used to prevent various adverse effects induced after succinylcholine. For investigating interactions between succinylcholine and small doses of four non-depolar-izing agents, the 112 subjects that were ASA class 1-2 and no existing neuromuscular conduction system disorder were divided into 5 groups that were control group(only succinylcholine 1 mg/kg) and pretreated group d-tubocurarine 0.5 mg/kg, atracurium 0.08 mg/kg, vecuronium 0.01 mg/kg and pancuronium 0.01 mg/kg. In each group, the plasma concentration of K+ and PChE before and after use of succinylcholine, fasciculation, onset and recovery time of succinylcholine block and intubating conditon were observed. The results are as follows; In the pretreated group, there were no significant changes of plasma concentration of K+ and plasma cholinesterase(Table 3) but diminished the incidence of fascieulation, delayed the onset time and shorted the recovery time of succinylcholine block(Table 4), and worse in intubating condition(Table 5) except pancuronium treated group. It was concluded that these seem to make worse condition of intubation, while small doses of nondepolarizing muscle relaxants except pancuronium antagonize depolarizing muscle relaxant.
Atracurium ; Fasciculation ; Incidence ; Intubation ; Pancuronium ; Plasma ; Succinylcholine* ; Tubocurarine ; Vecuronium Bromide

Subparalyzing dose of nodepolarizing relaxants prior to injection of succinylcholine has been used to prevent various adverse effects induced after succinylcholine. For investigating interactions between succinylcholine and small doses of four non-depolar-izing agents, the 112 subjects that were ASA class 1-2 and no existing neuromuscular conduction system disorder were divided into 5 groups that were control group(only succinylcholine 1 mg/kg) and pretreated group d-tubocurarine 0.5 mg/kg, atracurium 0.08 mg/kg, vecuronium 0.01 mg/kg and pancuronium 0.01 mg/kg. In each group, the plasma concentration of K+ and PChE before and after use of succinylcholine, fasciculation, onset and recovery time of succinylcholine block and intubating conditon were observed. The results are as follows; In the pretreated group, there were no significant changes of plasma concentration of K+ and plasma cholinesterase(Table 3) but diminished the incidence of fascieulation, delayed the onset time and shorted the recovery time of succinylcholine block(Table 4), and worse in intubating condition(Table 5) except pancuronium treated group. It was concluded that these seem to make worse condition of intubation, while small doses of nondepolarizing muscle relaxants except pancuronium antagonize depolarizing muscle relaxant.
Atracurium ; Fasciculation ; Incidence ; Intubation ; Pancuronium ; Plasma ; Succinylcholine* ; Tubocurarine ; Vecuronium Bromide

BACKGROUND: The purpose of this study was to assess the optimal time interval between rocuronium pretreatment and succinylcholine for prevention of the rise in serum potassium and creatine kinase concentrations and the increased incidence of fasciculations and myalgia following succinylcholine administration. METHODS: We have studied 60 patients undergoing a minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each were pretreated with saline 2 ml (Group C), 0.05 mg/kg rocuronium one min before (Group R1) or 3 min before (Group R3) 1.5 mg/kg succinylcholine administration. Serum potassium and creatine kinase were respectively measured 5 min after succinylcholine and 24 h after the operation. Fasciculations and myalgia on postoperative day 1 and day 2 were evaluated. RESULTS: The increase in the serum potassium concentration was not attenuated in any group. The increase in creatine kinase concentration, the incidence of fasciculations and the incidence of myalgia on postoperative day 1 and day 2 were highest in Group C; however, there was no difference between the Group R1 and R3. CONCLUSIONS: Either a 1 min or 3 min pretreatment time interval of the rocuronium has a similar effect on the prevention of the rise in serum potassium and creatine kinase concentrations and an increased incidence of fasciculations and myalgia following succinylcholine administration.
Creatine Kinase ; Fasciculation* ; Humans ; Incidence ; Myalgia* ; Potassium ; Prospective Studies ; Succinylcholine*