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October 02, 2008


Alan S. Black, MD

In the absence of d-tubocurare, the use of rocuronium to defasciculate prior to the administration of succinylcholine seems to have become a popular practice in anesthesia. Given the reasons that succinylcholine should be avoided, I can think of only a handful of INDICATIONS for succinylcholine's use as a first line muscle relaxant in ANY situation...those being the rapid securing of the airway, the desire to have the muscle relaxant dissipate quickly in the setting of a difficult airway, and procedures of very short duration that require muscle relaxation. The use of rocuronium prior to succinylcholine reduces the effectiveness of succinylcholine thereby necessitating a larger dose and subsequent duration of action. This practice seems to me to defeat the purpose for using succinylcholine in the first place! Lidocaine is efficacious for preventing succinylcholine-induced myalgias and would seem to be a better choice in most circumstances where succinylcholine is INDICATED for use. I would be interested in your opinions regarding this issue.

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