The Response of Succinylcholine from Blood Flow Occulusion

Kang, Kyu Sik; Kim, Soon Im; Kim, Sun Chong; Kim, Sung Yell

Abstract

The muscle relaxants produce a dose-dependent effect that is usually mediated through an interaction between drug concentration in the vicinity of the receptors and receptor occupancy. Unfortunately, neither of these two variables is easy to measure the concentration of a relaxant drug at the neuromuscular junction, especeially in anesthetized humans, so indirect estimates must be made. Therefore, plasma concentration of a relaxant drugs may be taken as a reasonable estimate of the concentration at the effector site related directly to the dose given and of the degree of deporalization at the acetylcholine receptors occupancy. Immediately after the intravenous bolus injection of succinylcholine, there is almost instantaneous mixing into blood and penetrating into the neuromuscular junction and hydrolyzed rapidly by an enzyme within one or two circulation of succinylcholine in the body, and is so rapid that it is generally not detectable with conventional venous blood sampling within one or two minute intervals. This study conform the response of the time related plasma concentration of succinylcholine dose given by nerve stimulation. The twitch response of the adductor pollicis muslce was monitored using supramaximal TOF stimulation of the ulnar nerve at the left wrist by ABM (Datex Co.) and twitch response was recorded from release of tourniquet at 1, 2, 3 and 4 minutes after succinylcholine was given into the right arm after blood flow was occlude with tourniquet at left upper arm (study group) and from administration of succinylcholine without blood flow occlusion (control group). Conclusively the time duration from release of tourniquet 1, 2, 3 and 4 minutes after injection of succinylcholine to 75% T(1) recovery were 73.2%, 31.5%, 15.2% and 0% of the non-occluded arm respectively. Comparing with over 90% depression of twitch height until 4 minute after succinylcholine given, plama concentration at 4 minute after succinylcholine given (study group) did not make any significantly change of twitch height (p>0.05).