A study of plasma potassium and electrocardiographic changes after a single dose of succinylcholine.

THE CUBItENT CONTROVERSY regarding the role of succinylcholine in producing cardiovascular disturbances deserves the careful attention of every anaesthesiologist. These changes, which may be catastrophic in nature, can occur after a single intravenous dose 1-~ as well as following repeated administrations. 4-9 The disturbances range from mild, transient changes in rate or rhythm through severe bradycardia and serious arrhythmias to cardiac arrest. Several theories have been offered to explain the causes, but none of them seems adequate. One of the most recent concerns the increase of plasma potassium immediately following the intravenous administration of succinylcholine. The release of plasma potassium as a result of damage to myofibrillae has been described. The occurrence of haemoglobinuria or myoglobinaemia after vigorous muscular exercises like forced marches, karate, 1~ or football 11,12 has been well documented, and several authors have described myoglobinaemia or myoglobinuria after the administration of succinylcho]ine. 13-15 A case of acute renal failure following the use of succinylcholine in a patient with idiopathic myoglobinuria was described by Bennike. 14 These phenomena (myoglobinuria, myoglobinaemia) after succinylcholine indicate myofibrillar damage and presumably the release of intracellular potassium. This study was designed to determine the incidence, magnitude and timing of plasma potassium changes and their correlation with electrocardiographic abnormalities following the administration of succinylcholine.

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