Eficacia de tres dosis de succinilcolina en la inducción de secuencia rápida / Effectiveness of three doses of succinylcholine in rapid sequence induction

Introducción: La intubación de secuencia de rápida es un procedimiento que minimiza el tiempo necesario para asegurar la vía respiratoria en pacientes con alto riesgo de broncoaspiración. Objetivo: Comparar la eficacia de tres dosis de succinilcolina en la inducción de secuencia rápida en pacientes con estómago y la calidad de la intubación, así como los efectos secundarios de dichos fármacos. Métodos: Se realizó un estudio observacional, de corte transversal para evaluar la calidad de la intubación con inducción de secuencia rápida en pacientes de urgencia, con estómago lleno. Se administraron 0,4 mg/kg de succinilcolina al grupo I, 0,6 mg/kg al grupo II y 1 mg/kg al grupo III. En todos los pacientes se evaluó la vía respiratoria. El estudio se realizó en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras" entre agosto de 2013 y 2016. Resultados: El tiempo de visualización de las cuerdas vocales fue rápido en los tres grupos. Los mejores resultados se obtuvieron en el grupo III, seguido del grupo II. Las condiciones de intubación fueron excelentes en el grupo III (90 %), buenas en grupo II (80 %) y regulares en el grupo I (70 %). Las variables hemodinámicas mostraron diferencias significativas entre grupos (p=0,008). Conclusiones: Se determinó la eficacia del empleo de tres dosis de succinilcolina en la inducción de secuencia rápida, con intubación óptima y segura cuando se empleó la succinilcolina a dosis de 1 mg/kg; pero con mayor porcentaje de alteraciones hemodinámicas como efectos adversos(AU)

Introduction: Rapid sequence intubation is a procedure that minimizes the time required to guarantee the respiratory airway in patients with high risk of bronchoaspiration. Objectives: To compare the quality of intubation with three doses of succinylcholine in rapid sequence induction in patients with full stomach, as well as the side effects of such drugs. Methods: An observational, cross-sectional study was carried out to assess the quality of intubation with rapid sequence intubation in emergency patients and with full stomach. The group I was administered 0.4 mg/kg of succinylcholine; the group II, 0.6 mg/kg; and the group III 1 mg/kg. The respiratory airway was assessed in all patients. The study was carried out in Hermanos Ameijeiras Clinical Surgical Hospital, between August 2013 and 2016. Results: The time of visualization of the vocal folds was fast in the three groups. The best results were obtained in the group III, followed by the group II. The intubation conditions were excellent in the group III (90%), good in the group II (80%), and fair in the group I (70%). The hemodynamic variables showed significant differences among the three groups (p=0.008). Conclusions: The effectiveness was determined of using three doses of succinylcholine in rapid sequence intubation, with optimal and safe intubation when succinylcholine was used at doses of 1 mg/kg, but it had a higher percentage of hemodynamic alterations as adverse effects(AU)

Prophylactic use of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia: a randomized, double-blinded, placebo-controlled study / Uso profilático de pregabalina para prevenção de mialgia e fasciculação induzidas por succinilcolina: estudo randômico, duplo-cego e controlado por placebo

ABSTRACT BACKGROUND: Succinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. OBJECTIVE: The present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. DESIGN: Prospective, randomized, placebo controlled, double blinded study. MATERIALS AND METHODS: Patients of both genders undergoing elective spine surgery were randomly assigned to two groups. Patients in Group P (pregabalin group) received 150 mg of pregabalin orally 1 h prior to induction of anesthesia with sips of water and patients in Group C (control group) received placebo. Anesthesia was induced with fentanyl 1.5 mcg/kg, propofol 1.5-2.0 mg/kg followed by succinylcholine 1.5 mg/kg. The intensity of fasciculations was assessed by an observer blinded to the group allotment of the patient on a 4-point scale. A blinded observer recorded postoperative myalgia grade after 24 h of surgery. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. RESULTS: Demographic data of both groups were comparable (p > 0.05). The incidence of muscle fasciculation's was not significant between two groups (p = 0.707), while more patients in group C had moderate to severe fasciculation's compared to group P (p = 0.028). The incidence and severity of myalgia were significantly lower in group P (p < 0.05). CONCLUSION: Pregabalin 150 mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.

RESUMO JUSTIFICATIVA: A succinilcolina é comumente usada para atingir um bloqueio neuromuscular profundo, de início rápido e de curta duração. OBJETIVO: Comparar a eficácia de pregabalina na prevenção de mialgia e fasciculação induzidas por succinilcolina. DESENHO: Estudo prospectivo, randômico, duplo-cego e controlado por placebo. MATERIAIS E MÉTODOS: Pacientes de ambos os sexos submetidos a cirurgia eletiva de coluna foram aleatoriamente divididos em dois grupos. Os pacientes do Grupo P (pregabalina) receberam 150 mg de pregabalina oral uma hora antes da indução da anestesia e os pacientes do Grupo C (controle) receberam placebo. A anestesia foi induzida com fentanil (1,5 mcg/kg) e propofol (1,5-2,0 mg/kg), seguidos de succinilcolina 1,5 mg/kg. A intensidade da fasciculação foi avaliada por um observador, cego para a alocação dos grupos, com uma escala de 4 pontos. Um observador cego registrou o grau pós-operatório de mialgia após 24 horas de cirurgia. Para o alívio da dor no pós-operatório, fentanil foi usado em sistema de analgesia controlada pelo paciente. RESULTADOS: Os dados demográficos de ambos os grupos eram comparáveis (p > 0,05). A incidência de fasciculação muscular não foi significativa entre os dois grupos (p = 0,707), enquanto mais pacientes do Grupo C apresentaram fasciculação de moderada a grave em relação ao Grupo P (p = 0,028). A incidência e a gravidade da mialgia foram significativamente menores no grupo P (p < 0,05). CONCLUSÃO: Pregabalina (150 mg) previne mialgia e fasciculação induzidas por succinilcolina, além de diminur o consumo de fentanil em cirurgia eletiva de coluna.

Statins and succinylcholine interaction: a cause of concern for serious muscular damage in anesthesiology practice!

Statins are being extensively used in cardiac patient throughout the globe. Succinylcholine has been the mainstay of profound relaxation during induction and intubation of anesthesia for almost six decades now. The interactive properties of these drugs have been of major concern during routine anesthesiology practice in the last few years. However, no major research trial, prospective studies or meta-analysis are available, which can truly allay the fears of possible potential negative synergistic interactions between these two commonly used drugs. Whatever the evidence is available is hardly enough to support a positive outcome and the results have been drawn from observations of only few small studies. As a result, a continuous need among anesthesiologist fraternity is felt to arrive at a suitable inference, which can predict definite consequences of this synergistic interaction. The present article reviews some of the important observations of few handful studies which were carried out to observe any potential adverse interactions between succinylcholine and statins

Succinilcolina vs rocuronio, escogencia clínica mediante un análisis de decisión médica / Succinylcholine vs rocuronium, clnical choice through a medical decision analysis

Objetivo: Realizar un análisis de decisión para escogencia entre succionilcolina y rocuronio en la inducción de secuencia rápida con base en su eficacia y la presentación de eventos adversos. Métodos: Se realizó el análisis de decisión mediante la construcción de árboles de decisiones, con sus respectivos nodos de decisión, oportunidades y utilidades. Los datos fueron tomados de la literatura médica y de una encuesta a profesionales de la anestesia y estudiantes de posgrado en anestesiología; luego éstos fueron procesados por el software Treenage con la realización de los análisis de sensibilidad. Resultados: El árbol de decisión de la literatura médica demuestra un valor esperado para la rama de succionilcolina de 6.50, superior al de la rama de rocuronio, cuyo valor es de 5.22. El árbol de decisión de la encuesta muestra a la succionilcolina como opción a escoger con un valor esperado de 9.08, por encima del valor esperado del rocuronio el cual es de 8.17. Conclusión: La succionilcolina es la mejor escogencia con base en su efectividad clínica para condiciones de intubación traqueal en la inducción de secuencia rápida, y también, es la mejor opción cuando se tienen en cuenta sus efectos adversos.

Objective: To perform a decision analysis for choosing between succinylcholine and rocuronium in a rapid sequence induction situation based on their efficacy and reported adverse effects. Methods: Decision analysis by building decision trees, with their respective decision nodes, opportunities and usefulness was made. The data was taken from the medical literature and a survey performed on anesthesia professionals and anesthesiology residents; then was processed by the Treenage software with sensitivity analysis. Results: The decision tree based on the medical literature shows an expected value for the succinylcholine branch of 6.50, higher than the rocuronium branch with a value of 5.22. The decision tree of the survey shows the succinylcholine as an option to choose with an expected value of 9.08, above the expected value of rocuronium which is 8.17. Conclusion: Succinylcholine is the best choice based on tis clinical effectiveness conditions for tracheal intubation in rapid sequence induction, and it is the best option when consideration its adverse effects.

Effects of Rocuronium pretreatment on muscle enzyme levels following succinylcholine

Succinylcholine revolutionized anaesthetic practice by providing intense neuromuscular blockade of very rapid onset and ultrashort duration, thereby greatly easing the maneuver of tracheal intubation. However the worth of succinylcholine is limited by the frequent occurrence of muscular side effects which manifest biochemically in the form of rise in serum creatine kinase [CK]. The administration of small doses of nondepolarizing muscle relaxants before the administration of succinylcholine has been shown to decrease the incidence and severity of muscular side effects experienced by the patients. This study was aimed at evaluating the efficacy of technique in reducing the muscular side effects of succinylcholine, biochemically manifested as rise in CK. Sixty healthy adults were enrolled in the study who were scheduled for minor muscle cutting surgeries under general anaesthesia. They were assigned at random to two groups of thirty patients each. They randomly received succinylcholine for intubation and a precurarization dose of Rocuronium followed by succinylcholine for intubation. Blood samples were drawn for estimation of serum creatine kinase. There was a significantly raised CK in the succinylcholine group. In the precurarization group the rise in CK was prevented and the levels were significantly less as compared to the group which received succinylcholine alone. Present study concluded that precurarization with Rocuronium was effective in reducing the succinylcholine-induced rise in creatine kinase

Pretreatment with remifentanil is associated with less succinylcholine-induced fasciculation

Succinylcholine is a popular muscle relaxant and one of its most common side effects is muscle fasciculation. The purpose of this study was to evaluate the efficacy of remifentanil in preventing succinylcholine-induced fasciculation in patients undergoing general anesthesia. In aprospective, double blind study, 60 ASA I and II patients were randomly assigned into two groups [30 each] to receive either remifentanil 1 micro g/kg [Group R], or saline 3 ml [Group S] as a pretreatment agent, one minute before induction of general anesthesia by propofol, fentanyl, and 1.5 mg/kg succinylcholine. The duration and the intensity of fasciculation were assessed using a four-point rating scale. Data were analyzed by Mann-Whitney U-test, Fisher exact test and Student-t-test using SPSS software. In the remifentanil group the duration [p<0.001] and the intensity [p<0.001] of fasciculation were lower compared to the saline group. However the incidence of bradycardia was higher in the remifentanil group in comparison to the group which received normal saline. Our findings indicate that remifentanil can reduce the duration and the intensity of succinylcholine induced fasciculation. However, it induces greater bradycardia

Successful resuscitation of prolonged hyperkalemic cardiac arrest following succinylcholine administration in possibly undiagnosed myopathy

We report a 3 years old male with undiagnosed myopathy, who developed cardiac arrest secondary to hyperkalemia following succinylcholine administration.The patient underwent prolonged cardiopulmonary resuscitation [CPR], which ended successfully after applying external pace maker. He was discharged home eleven days after the cardiac arrest for follow up of his myopathy

The Thai anesthesia incident monitoring study of perioperative allergic reactions: an analysis of 1996 incidents reports.

OBJECTIVES: Analyze the clinical course, management, outcome, and contributing factors of perioperative allergic reactions in the Thai Anesthesia Incident Monitoring Study (Thai AIMS). MATERIAL AND METHOD: A prospective descriptive multicenter study was conducted in 51 hospitals across Thailand Voluntary, anonymous reports of any adverse or undesirable events during the first 24 hours of anesthesia were sent to the Thai AIMS data management unit. Possible perioperative allergic reactions were extracted and examined independently by three peer reviewers. RESULTS: Forty-three reports of possible perioperative allergic reactions from the 2,537 incidents reported to the Thai AIMS (1.6%) were reviewed. There was a female predominance (1.9:1). The most common features were cutaneous manifestations (93%), arterial hypotension (20.1%), and bronchospasm (11.6%) respectively. The severity grades were 69.8% in grade I, 4.7% in grade II, and 25.6% in grade III. The three most suspected causative agents were neuromuscular blocking agents (39.5%, 30.2%-succinylcholine), antibiotics (27.9%), and opioids (18.6%) respectively. All but one responded well to treatment with complete recovery. One patient suffered acute myocardial infarction and had to stay at the hospital for longer than one week. None had further allergic reaction. CONCLUSION: Perioperative allergic reactions accounted for 1.6% of anesthetic adverse events. The most common features were cutaneous manifestations. A quarter of these were life-threatening but responded well to treatment. The most common suspected causative agent was succinylcholine.

Precurarización con rocuronio y d-tubocurarina: otra perspectiva / Precurarization with rocuronium and d-tubocurarine

Objetivo: Estudiar la precurarización de la succinilcolina utilizando d-tubocurarina y rocuronio introduciendo los métodos restrictivo, conceptos de velocidad de acción y recuperación y una nueva semiología para evaluar las fasciculaciones. Material y método: Se administraron succinilcolina (1 mg x Kg-1) (n =21) sola o precedida por rocuronio o d-tubocurarina (60 ó 50 ug x Kg-1) (n =21 c/u), determinándose: la fase inicial de comienzo hasta 80 por ciento de bloqueo, tiempo de comienzo, máximo efecto, duración clínica, tiempo de reversión espontánea entre 10 por ciento y 25 por ciento y 25 por ciento a 50 por ciento. Se calculó la velocidad de acción (inicial, final y global) como la relación tiempo/bloqueo fraccionado y la velocidad de recuperación. El método restrictivo fue empleado para el estudio del tiempo de comienzo, utilizando un rango restringido de bloqueo. Las fasciculaciones fueron evaluadas por su intensidad en seis regiones anatómicas por cuatro observadores imparciales e independientes y las medias de sus valoraciones utilizadas para analizarlas. Resultados: Aparentemente ambos desfasciculantes prolongan la fase inicial, tiempo de comienzo y velocidad de la succinilcolina, pero el método restrictivo únicamente lo confirmó para el tiempo de comienzo y la velocidad global. La velocidad inicial fue más rápida que la final. El rocuronio redujo el efecto y la duración clínica e incrementó la velocidad de recuperación de la succinilcolina. Las fasciculaciones fueron más frecuentes e intensas en el tronco y miembro superior izquierdo, pero los precurarizantes las redujeron tanto en intensidad como localización Discusión: La precurarización no modifica la fase inicial de comienzo, surgiendo la posibilidad de practicar una intubación temprana. Debido al acortamiento que provoca la precurarización con rocuronio se hace evidente la necesidad precoz de nuevas dosis de relajantes.

Objective: To study the precurarization of succinylcholine with d-tubocurarine and rocuronium, using the restrictive method, speed of action and recovery principles and a particular evaluation for fasciculations Material & Methods: Patients received succinylcholine (1 mg x Kg-1) (n =21) either alone or preceded by d-tubocurarine or rocuronium (60 ó 50 micron g x Kg-1) (n =21 e/a), and the following clinical measurements were made: earlyphase of onset time (up to 80 percent blockade), onset time, maximal block, clinical duration and recovery time between 10 percent and 25 percent and 25 percent to 50 percent. Speed of action (initial, final and global)as the ratio between time and fractional blockade and speed of recovery, were calculated. Restrictive method was used for the study of the entire onset time on patients included in a limited range of final block. Intensity of fasciculations was evaluated by four independent observers blind to the drugs used in six anatomical regions and their mean values used for analysis. Results: Apparently, precurarizing drugs prolonged initial phase, onset time and reduced speed for succinylcholine, but only onset time and global speed were confirmed by restrictive method. After rocuronium, maximal effect as well as clinical duration of succinylcholine werereduced and speed of recovery increased. Fasciculations were more frequent and intense at the trunk and left upper arm, but precurarization reduced both intensity and localization prevalence. Discussion: As lack of changes on the initial phase of onset time for succinylcholine inducedby precurarization was noticed, an early tracheal intubation could be contemplated. Due to reduction on clinical duration after rocuronium,new doses of muscle relaxants are sooner necessary. The present method for evaluation of fasciculations shows how far they are spread and how effective precurarization was, given rise to doubts on previous results.

Hipertermia maligna: adelantándose a las complicaciones / Malignant hyperthermia: moving forward before the complications

La hipertermia maligna (HTM) es una enfermedad fármaco-genética de carácter autosómico dominante de baja incidencia pero potencialmente mortal, caracterizada por un síndrome hipermetabólico del músculo estriado esquelético, que puede desencadenar la destrucción completa de éste, resultando en aumento de la temperatura corporal, alto consumo de oxígeno, hiperpotasemia, falla renal y arritmias. A continuación se da a conocer el caso de un paciente de 6 años portador de una distrofia muscular de Duchenne con antecedentes familiares de hipertermia maligna y que se sometió a cirugía adenoamigdaliana en la cual se tomaron las medidas anestésicas para prevenir la aparición de una crisis.

Malignant hyperthermia: a case report in Thai Anesthesia Incidents Study (THAI Study).

A 3-year-old Thai boy underwent open reduction and internal fixation with K-wire of condylar fracture of humerus under general anesthesia. The patients developed generalized muscle regidity, masseter muscle spasm, elevated creatinine kinase, high temperature (39.3 C), inappropriate tachycardia, and arterial base excess was more than-8 mEq/L. The clinical grading scale of diagnosis of malignant hyperthermia was 58 (grade D6; almost certain malignant hyperthermia). Succinylcholine has been identified as the trigger agent, as other possible trigger agents were not involved. The treatment included hyperventilation, external cooling and cold IV fluids without administration of dantrolene. The patient fully recovered and discharged on day 12. This case report showed an incidence of malignant hyperthermia of approximated 1:150,000 in Thai Anesthesia Incidents Study (THAI Study).

Study on the effect of alfentanil and sufentanil on fasciculation of succinylcholine

Succinylcholine is a depolarizing muscle relaxant that is widely used by anesthesiologists especially at induction time to facilitate intubations. Fasciculation is common after intravenous injection of succinylcholine and preceeding relaxation may cause myalgia, rhabdomyolysis and increase in blood level of myoglobulin. On the other hand, narcotics are the main components of induction protocols and alfentanil as a short acting narcotic is widely used. Decreasing fasciculation can be achieved probably by use of alfentanil. Alfentanil and Sufentanil were used in our study to evaluate this proposal. Patients were selected randomly [female aged 20-50, ASA I]. Induction of anesthesia was done by thiopental Na [4mg/kg] and relaxation for intubation reached by Succinylcholine [1mg/kg]. Premedication was as follows: in the 1[st] group alfentanil [10 micro g/kg, 2 minutes before Succinylcholine injection]; in the 2[nd] group Sufentanil [0.1micro g/kg, 4 minutes before Succinylcholine injection] and in the 3 [rd] group [control group] normal saline [0.5-2 ml, 2 minutes before Succinylcholine injection]. The zero score was 64%, 12% and 8% in groups 1 to 3 respectively while the three scores were 15%, 50% and 57% in groups 1 to 3 respectively. Statistical analysis revealed that alfentanil induced more fasciculation suppression than sufentanil [p<0.0001]

High dose rocuronium or cisatracurium is a reliable alternative to succinylcholine for rapid sequence intubation

Endotracheal intubation conditions after 60 seconds following intravenous administration of succinylcholine [1 mg/kg, n=20], rocuronium [1.2 mg/kg, n=20], cisatracurium [0.15 mg/kg, n=20], or cisatracurium [0.2 mg/kg, n=20] were evaluated and compared. No significant differences were found between the doses of the three drugs. Intubation conditions were characterized as excellent or good in 90% of patients received cisatracurium 0.15 mg/kg and in 95% of patients received succinylcholine 1 mg/kg, rocuronium 1.2 mg/kg or cisatracurium 0.2 mg/kg. High dose rocuronium 1.2 mg/kg, cisatracurium [0.15-0.2 mg/kg], provides satisfactory intubation conditions after 60 seconds and can be used safely instead of succinylcholine for rapid-sequence intubation when a long duration of neuromuscular blockade is acceptable. High dose rocuronium superior to high dose cisatracurium, if rapid onset is concerned, however cisatracurium has a shorter duration of action

Muscle pain after succinylcholine injection and its management

The purpose of this study was to assess the percentage of patients experiencing post-succinylcholine pain and outcome of the management. It was a comparative study conducted in the Department of Anesthesiology of post Graduate Lady Reading Hospital, Peshawar from September 1996 to February 1997. Eighty ASA I and II adults undergoing tonsillectomy were studied for the effects of pre-operative administration of pancuronium bromide on succinylcholine induced myalgia. Patients were randomly divided into two groups, one group received succinylcholine as a muscle relaxant, while the other group received pancuronium bromide as a pretreatment agent 3 minute before succinyl. Muscle fasciculations, intubation conditions and post-operative myalgia were graded numerically. Post-operative myalgia in the group treated with pancuronium bromide was significantly less [<0.05] than in the control group

Can lidocaine reduce succinylcholine induced postoperative myalgia?

This study was undertaken to determine the effect of lidocaine pretreatment on reduction of succinylcholine-induced myalgia in patients undergoing general anesthesia for gynecological surgery. One hundred and thirty-five patients were assigned to one of three groups in a prospective, double blind, randomized manner. Group PS, the control group, received normal saline and succinylcholine 1.5 mg x kg(-1); Group LS, lidocaine 1.5 mg x kg(-1) and succinylcholine 1.5 mg x kg(-1); Group PR, normal saline and rocuronium 0.6 mg x kg(-1). Morphine 0.1 mg x kg(-1) iv was given for premedication and all patients were monitored with a noninvasive blood pressure monitor, ECG and pulse oximetry. Anesthesia was induced with 5 mg.kg(-1) thiopental iv. followed by succinylcholine (Group PS, LS) or rocuronium (Group PR) for tracheal intubation. Following administration of these agents, the presence, and degree of fasciculation were assessed visually on a four point scale by one investigator who was blinded to the drug administered. The blood pressure and heart rate of each patient were monitored on nine occasions. Twenty-four hours later, any myalgia experienced was assessed according to a structured questionaire and graded by a four point scale by one investigator blinded to the intraoperative management. The results indicate that muscle fasciculation was not found in Group PR while the patients in Group LS had a lower incidence of muscle fasciculation than those in Group PS (p < 0.001). At 24 h, the incidence of myalgia was higher in Group PS than in Group LS and PR (p < 0.05). A correlation was not found between the incidence of myalgia and the occurrence of muscle fasciculation. The changes in systolic and diastolic blood pressure and heart rate were not significant among the three groups. In conclusion, where succinylcholine is used, lidocaine is proven to be the useful pretreatment agent for the reduction of postoperative myalgia.

Análisis del comportamiento de rocuronio, mivacurio y succinilcolina en la intubación endotraqueal / Analysis of the effects of rocuronium, mivacurium and succinocholine for endotracheal intubaction. midazolam as induction agent in pediatry

Se estudiaron las dosis y condiciones de intubación y relajación muscular en 60 pacientes programados para cirugía electiva en el HAL. A los mismos se les aplicó una dosis estándar de 2 mg de midazolam al llegar al quirófano, para continuar con la inducción con tiopental. Se facilitó la intubación con succinilcolina a 1 mg/kg en el grupo I (n=20), mivacurio 250 µg/kg en el grupo II (n-20) y rocuronio 0.6 mg/kg en el grupo III (n = 20). Se valoraron las condiciones para la intubación, a los 90 seg de la administración de los relajantes, el mantenimiento fue con enfluorane, con ventilación controlada, valorando el perfil de acción de cada medicamento a lo largo del procedimiento. La recuperación se valoró, a través del monitoreo continuo con un equipo TOF Guard en la modalidad de tren de cuatro y twitch, revirtiendo al final del procedimiento todos los casos donde se emplearon relajantes no despolarizantes con prostigmina y atropina a dosis habituales. Las condiciones de intubación a los 90 seg, fueron mejores en el grupo de succinilcolina y rocuronio en comparación al mivacurio. El tiempo de inicio llegando a un bloqueo del 85 por ciento en el caso de succinilcolina, fue de 61 ñ 18 seg, que significativamente menor al del rocurio 96 ñ 46 seg, y mivacurio 200 ñ 81 seg respectivamente. el tiempo de recuperación que se consideró cuando se presento un 25 por ciento del valor control, fue significativamente fue menor con succinilcolina y mivacurio que con rocuronio. La relajación muscular se mantuvo durante más tiempo en forma significativa con rocuronio. En relación a efectos colaterales, solo se apreció una leve respuesta histaminogena manifestada por rash mínimo en cuello y parte superior del tórax en 5 pacientes, a quienes se le aplicó mivacurio. Desde el punto de vista hemodinámico, no se presentaron cambios de importancia. El rocuronio, parece ser una excelente alternativa cuando se busca una intubación rápida sin embargo es conveniente referir que a mayor dosis con este relajante, mayor duración al momento. Por tanto podemos concluir que al momento, la succinilcolina puede ser suplida tanto en su rapidez de inicio con un producto y el otro por su rápida recuperación