Hemoglobin Desaturation after Succinylcholine-induced Apnea

Background: Because of the rapid recovery of neuromuscular function after succinylcholine administration, there is a belief that patients will start breathing sufficiently rapidly to prevent significant oxygen desaturation. The authors tested whether this belief was valid. Methods: Twelve healthy volunteers aged 18–45 yr participated in the study. After preoxygenation to an end-tidal oxygen concentration greater than 90%, each subject received 5 mg/kg thiopental and 1 mg/kg succinylcholine. Oxygen saturation (SaO2) was measured at both a finger and an ear lobe (beat to beat). During the period of apnea and as they were recovering, the volunteers received continuous verbal reassurance by the investigators. If the SaO2 decreased below 80%, the volunteers received chin lift and, if necessary, assisted ventilation. The length of time the subject was apneic and level of desaturation were related by linear regression analysis. One hour after recovery and again 1 week later, subjects were asked a series of questions regarding their emotional experience. Results: In six volunteers, SaO2 decreased below 95% during apnea; in four, SaO2 decreased below 80%, necessitating chin lift and assisted ventilation in three. Apnea time was significantly longer in volunteers who reached SaO2 less than 80% than in those who did not (7.0 6 0.4 and 4.1 6 0.3 min, respectively), and there was a significant correlation between the length of time the subject was apneic and the magnitude of desaturation. Conclusions: Spontaneous recovery from succinylcholine-induced apnea may not occur sufficiently quickly to prevent hemoglobin desaturation in subjects whose ventilation is not assisted.

[1]  V. Slavov,et al.  Effects of an intubating dose of succinylcholine and rocuronium on the larynx and diaphragm: an electromyographic study in humans. , 1999, Anesthesiology.

[2]  B. Kolk,et al.  Awareness during anesthesia and posttraumatic stress disorder. , 1998, General hospital psychiatry.

[3]  C. Madler,et al.  Conscious awareness during general anaesthesia: patients' perceptions, emotions, cognition and reactions. , 1998, British journal of anaesthesia.

[4]  J. Benumof,et al.  Critical Hemoglobin Desaturation Will Occur before Return to an Unparalyzed State following 1 mg/kg Intravenous Succinylcholine , 1997, Anesthesiology.

[5]  J. Severinghaus,et al.  Hypoxic ventilatory response predicts the extent of maximal breath-holds in man. , 1995, Respiration physiology.

[6]  Ronald D. Miller,et al.  Onset and Duration of Rocuronium and Succinylcholine at the Adductor Pollicis and Laryngeal Adductor Muscles in Anesthetized Humans , 1994, Anesthesiology.

[7]  R. Lansing,et al.  The experience of complete neuromuscular blockade in awake humans. , 1994, Journal of clinical anesthesia.

[8]  B. Bonke,et al.  Awareness and Recall during General Anesthesia: Facts and Feelings , 1993, Anesthesiology.

[9]  J. van Egmond,et al.  Factors affecting magnitude and time course of neuromuscular block produced by suxamethonium. , 1992, British journal of anaesthesia.

[10]  R. Lo,et al.  Arterial Desaturation during Induction in Healthy Adults: Should Preoxygenation be a Routine? , 1991, Anaesthesia and intensive care.

[11]  R. Wahba,et al.  Perioperative functional residual capacity , 1991, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[12]  C. Meistelman,et al.  Vecuronium neuromuscular blockade at the diaphragm, the orbicularis oculi, and adductor pollicis muscles. , 1990, Anesthesiology.

[13]  J. Severinghaus,et al.  Accuracy of Response of Six Pulse Oximeters to Profound Hypoxia , 1987, Anesthesiology.

[14]  J. Williams,et al.  Pulmonary physiology in the postoperative period. , 1987, Critical care clinics.

[15]  J. Lerman,et al.  Neuromuscular blockade for rapid tracheal intubation in children: comparison of succinylcholine and pancuronium , 1986, Canadian Anaesthetists' Society journal.

[16]  F. Donati,et al.  Potency of Pancuronium at the Diaphragm and the Adductor Pollicis Muscle in Humans , 1986, Anesthesiology.

[17]  W. M. Wahba,et al.  Influence of Aging on Lung Function‐Clinical Significance of Changes from Age Twenty , 1983, Anesthesia and analgesia.

[18]  D. R. Cook,et al.  Neuromuscular Blocking Effects of Succinylcholine in Infants and Children , 1975, Anesthesiology.

[19]  A. B. Dubois,et al.  The relationship between airway resistance, airway conductance and lung volume in subjects of different age and body size. , 1958, The Journal of clinical investigation.