December 10, 1973

Succinylcholine Effects in Anesthesia

Author Affiliations

Massachusetts General Hospital Boston

JAMA. 1973;226(11):1359-1360. doi:10.1001/jama.1973.03230110047021

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To the Editor.—  In reply to the suggestion of Drs. Kimbrough and Suggs (225:1532, 1973) that all patients who are to receive succinylcholine should be screened for atypical or low pseudocholinesterase, I offer the following comments:First, the expense of performing several million dibucaine numbers per year would run into several millions of dollars, unnecessarily.Second, a simple clinical test can be performed to evaluate the patient's ability to metabolize succinylcholine. One administers succinylcholine, 0.1 mg/kg of body weight, to the spontaneously breathing patient after anesthesia is induced. Clinically evident respiratory embarrassment occurs rarely after this dose in individuals able to metabolize succinylcholine normally. If respiratory depression does appear, it is transient and should clear spontaneously within less than five minutes. If, on the other hand, the patient is unable to metabolize the drug because he has an atypical enzyme or low enzyme activity, then he should develop severe paralysis,