Newly Published
Correspondence  |   August 2019
Succinylcholine Use and Dantrolene Availability: Comment
Author Notes
  • University of Texas Southwestern Medical School, Dallas, Texas (G.P.J.). girish.joshi@utsouthwestern.edu
  • (Accepted for publication May 18, 2019.)
    (Accepted for publication May 18, 2019.)×
Article Information
Correspondence
Correspondence   |   August 2019
Succinylcholine Use and Dantrolene Availability: Comment
Anesthesiology Newly Published on August 27, 2019. doi:10.1097/ALN.0000000000002949
Anesthesiology Newly Published on August 27, 2019. doi:10.1097/ALN.0000000000002949
We read with interest the study by Larach et al.,1  which performed extensive and complex analyses of three databases (i.e., Multicenter Perioperative Outcomes Group, the North American Malignant Hyperthermia Registry, and the Anesthesia Closed Claims Project) as well as performed a systematic review of literature. One of the conclusions of the study was that succinylcholine alone without volatile anesthetics may trigger malignant hyperthermia (MH). The authors seem to allude that this finding negates the Society for Ambulatory Anesthesia recommendation2  that permits Class B ambulatory facilities to stock succinylcholine for rescue of laryngospasm without stocking dantrolene. However, the Larach et al. study1  has significant limitations, particularly the fact that the analyses did not include data from Class B facilities or the use of succinylcholine for laryngospasm. The succinylcholine dose used for situations assessed in this study (i.e., possible difficult airway or electroconvulsive therapy) is generally much higher, and extrapolating the conclusions to low-dose (20 to 30 mg) succinylcholine commonly used to treat laryngospasm may be inappropriate. Of note, there are no reports of MH with low-dose succinylcholine. Also, as stated in the accompanying editorial by Hopkins,3  “the evidence presented in this article is insufficient to convince me that succinylcholine in the absence of volatile anesthetics can trigger a life-threatening progressive hypermetabolic response in MH–susceptible patients...”