ABSTRACT
Plasma Cholinesterase Deficiency is an autosomal recessive inherited blood plasma enzyme abnormality in which the Body's production of butyrylcholinesterase is impaired resulting in prolonged apnoea following depolarising muscle relaxants like Succinyl Choline (Suxamethonium) or Mivacurium. This is associated with paralysis & little or no neurological response. Individuals with plasma cholinesterase (Pseudocholinesterase) deficiency are often diagnosed only after experiencing prolonged apnoea after standard intubating dose of Succinyl Choline. Plasma Cholinesterase is not produced artificially & can be supplied through Blood & fresh frozen plasma. Hence treatment includes mechanical ventilation & supplementation of either whole blood or fresh frozen plasma
ABSTRACT
Background: Endotracheal intubation is required for giving general anesthesia for which adequate muscle relaxation is necessary Suxamethonium is still used as a relaxant for endotracheal intubation Rocuronium, a nondepolarizing muscle relaxant was compared here for tracheal intubating conditions Aim of the study: To compare the intubating conditions achieved in patients undergoing elective surgeries under General Anaesthesia with Suxamethonium or Rocuronium in 60 secs and complications in both groups Materials and methods: This study was conducted in Institute of Anaesthesiology and Critical care at Madras medical college, Chennai during the period 2014 – 15100 patients of ASA I and II were divided randomly into 2 groups undergoing elective surgeries: Group I - Suxamethonium Group II - Rocuronium assessed for intubating conditions after administration of the corresponding drug Results: The intubating conditions were excellent in group I Suxamethonium as against Group II Rocuronium in 60 secs According to the cooper scoring system the scores of vocal cord movement in group I (Suxamethonium) was 268 (mean) ± 0471 and in group II (Rocuronium) was 234±0557, the scores of response to intubation in group I (Suxamethonium) was 298±0141 and in group II (Rocuronium) was 270±0463 with better intubating conditions in group I receiving Suxamethonium than Rocuronium The results were significant with a p-value of<005 whereas the scores of jaw Stalin R, Raja Manikandan S A prospective, randomized controlled study to compare the intubating conditions achieved with suxamethonium and rocuronium bromide IAIM, 2018; 5(12): 72-76 Page 73 relaxation in group I patients (Suxamethonium) was 270 (mean)±0463 and group II patients (Rocuronium) was 252±0544 with better jaw relaxation Conclusion: Rocuronium can be used as an alternative when suxamethonium is contraindicated for rapid intubation but not if the anticipated difficult airway is present Rocuronium can be chosen as an alternative to it even in rapid sequence intubation in emergency cases, provided the airway is properly assessed and no anticipated difficult intubation is present
ABSTRACT
Objective To observe and analyze the performance of forensic science in the cases of suxamethonium chloride poisoning,and to improve the identification of suxamethonium chloride poisoning.Methods Fifty-four cases of suxamethonium chloride poisoning were collected.The rules of determination of suxamethonium chloride poisoning were observed by the retrospective analysis of pathological and toxicological changes as well as case features.Results The pathological features of suxamethonium chloride poisoning were similar to the general changes of sudden death,which mainly included acute pulmonary congestion and edema,and partly showed myocardial disarray and fracture.Suxamethonium chloride could be detected in the heart blood of all cases and in skin tissue of part cases.Conclusion Suxamethonium chloride poisoning has the characteristics with fast death and covert means,which are difficult to rescue and easily miss inspection.For the cases of sudden death or suspicious death,determination of suxamethonium chloride should be taken as a routine detection index to prevent missing inspection.
ABSTRACT
Background: Endotracheal intubation is of paramount importance in general anaesthesia requires relaxation of laryngeal musculature leading to total inactivity of vocal cords. Suxamethonium chloride, a depolarizing muscle relaxant due to its quick onset of action and excellent intubating conditions has remained a muscle relaxant of choice. Rocuronium was proved to be safe alternative to suxamethonium for endotracheal intubation. Aims & Objective: To find out the utility of Inj. Rocuronium Bromide a non-depolarizing muscle relaxant (NDMR) as an alternative to Suxamethonium chloride, a depolarizing muscle relaxant (DMR) for the purpose of intubation of trachea with emphasis on onset of time for muscle relaxation, duration of action, hemodynamic changes and complications if any. Materials and Methods: This is a randomized clinical study carried out at tertiary care center. 90 patients were randomly divided into three groups. Group S60 (n=30) - Inj. Suxamethonium 1.5 mg/kg IV given I.V, Group R60 (n=30) - Inj. Rocuronium 0.6 mg/kg IV given I.V and Group R90 (n=30) - Inj. Rocuronium 0.6 mg/kg IV given I.V. The intubating conditions were judged clinically at fixed time interval i.e. either at 60 seconds or 90 seconds as per the group of patient, after the injection of study drug with the help of four point scale. The observed results were compiled and analyzed statistically by using chi-square test for qualitative data and students “t” test for quantitative data, the analysing system being that of EPI INFO. Results: The mean age was 29.2 ± 12.60, 28.83 ± 8.50 & 30.1 ± 10.47 years, respectively in S60, R60 and R90 group. Intubating conditions were excellent (score 8-9) in all the 30 patients (100%) in Group S60, in 23 patients (76.66%) of Group R60 and in 28 patients (93.33%) of Group R90. The mean onset time in our study were 46.66±5.46 seconds in Group S60, 76.33 ± 10.33 seconds in Group R60 and 78.33 ± 9.4 in R90. The duration of action in our study was 5.93 ± 1.25 minutes in Group S60 compared to 29.83±5.49minutes in Group R60 and 27.83 ± 3.13 minutes in R90. Conclusion: Rocuronium can serve as a good alternative to Suxamethonium for tracheal intubation in conditions where Suxamethonium is contraindicated or where its use is hazardous.