Severe life-threatening hyperkalaemia may occur following administration of suxamethonium during certain periods after burns, neurological injuries, and in certain other conditions. Although this response is well-known, there is disagreement about when it may occur. This review describes the normal hyperkalaemic response to suxamethonium, the factors affecting it, the conditions in which it may be exaggerated, and the periods of high risk.
NashC.L., HallerR., BrownR.H.Succinylcholine, paraplegia and intra-operative cardiac arrest. J Bone Joint Surg1981; 63-A: 1010–2.
17.
CoopermanL.H.Succinylcholine-induced hyperkalaemia in neuromuscular damage. JAMA1970; 213: 1867–71.
18.
Azar I.The response of patients with neuromuscular disorders to muscle relaxants: a review. Anesthesiology1984; 61: 173–87.
19.
TobeyR.E., JacobsenP.M., KahleC.T., ClubbR.J., DeanM.A.The serum potassium response to muscle relaxants in neural injury. Anesthesiology1972; 37: 332–7.
20.
WeinstraubH.D., HeisterkampD.V., CoopermanL.H.Changes in plasma potassium concentration after depolarising blockers in anesthetized man. Br J Anaesth1969; 41: 1048–52.
21.
MazzeR.I., EscueH.M., HoustonJ.B.Hyperkalaemia and cardiovascular collapse following administration of succinylcholine to the traumatized patient. Anesthesiology1969; 31: 540–7.
22.
CairoliV.J., IvankovichA.D., VucicevicD., PatelK.Succinylcholine-induced hyperkalaemia in the rat following radiation injury to muscle. Anesth Analg1982; 61: 83–6.
23.
LaycockJ.R., LoughmanE.Suxamethonium-induced hyperkalaemia following cold injury. Anaesthesia1986; 41: 739–41.
24.
GeorgeA.L., WoodC.A.Succinylcholine-induced hyperkalaemia complicating the neuroleptic malignant syndrome. Ann Int Med1987; 106: 172.
25.
TongT.K.Succinylcholine-induced hyperkalaemia in near-drowning. Anesthesiology1987; 66: 720.
26.
SmithR.B., GrenvikA.Cardiac arrest following succinylcholine in patients with central nervous system injuries. Anesthesiology1970; 33: 558–60.
StevensonP.H., BirchA.A.Succinylcholine-induced hyperkalaemia in a patient with a closed head injury. Anesthesiology1979; 51: 89–90.
29.
FrankvilleD.D., DrummondJ.C.Hyperkalaemia after succinylcholine administration in a patient with closed head injury without paresis. Anesthesiology1987; 67: 264–6.
30.
IwatsukiN., KurodaN., AmahaK., IwatsukiK.Succinylcholine-induced hyperkalaemia in patients with ruptured cerebral aneurysms. Anesthesiology1980; 53: 64–7.
31.
ThomasE.T.Circulatory collapse following succinylcholine: report of a case. Anesth Analg1969; 48: 333–7.
32.
CowgillD.B., LucilleA.M., ShapiroH.M.Encephalitis and a hyperkalaemic response to succinylcholine. Anesthesiology1974; 40: 409–11.
33.
CoopermanL.H., StrobelG.E., KennellE.M.Massive hyperkalaemia after administration of succinycholline. Anesthesiology1970; 32: 161–4.
MintonM.D., StirtJ.A., BedfordR.F.Serum potassium following succinylcholine in patients with brain tumours. Can Anaesth Soc J1986; 33: 328–31.
36.
FergussonR.J., WrightD.J., WilleyR.F., CromptonG.K., GrantI.W.B.Suxamethonium is dangerous in polyneuropathy. Br Med J1981; 1: 298–9.
37.
NicholsonM.J.Circulatory collapse following succinylcholine: report of a patient with diffuse lower motor neuron disease. Anesth Analg1971; 50: 431–7.
38.
WaltonJ.D., FarmanJ.V.Suxamethonium hyperkalaemia in uraemic neuropathy. Anaesthesia1973; 28: 666–8.
39.
KluppH., KrauppO., HonetzN., KoblingerW., LoudinM.Uber die Freisetzung von Kalium aus der Muskulatur unter der Einwirkung einiger Muskelrelaxentien. Arch Internat Pharmacodyn1954; 98: 340–54.
40.
PatonW.D.M.Mode of action of neuromuscular blocking drugs. Br J Anaesth1956; 28: 470–80.
41.
EversW., RaczG.B., DobkinA.B.A study of plasma potassium and electrocardiographic changes after a single dose of succinylcholine. Can Anaesth Soc J1969; 16: 273–81.
42.
ListW.F.Serum potassium changes during induction of anaesthesia. Br J Anaesth1967; 39: 480–4.
43.
PatonW.D.M.The effects of muscle relaxants other than muscle relaxation. Anesthesiology1959; 20: 453–63.
44.
HenningR.D., BushG.H.Plasma potassium after halothane-suxamethonium induction in children. Anaesthesia1982; 37: 802–5.
45.
KeneallyJ.P., BushG.H.Changes in serum potassium after suxamethonium in children. Anaesth Intens Care1974; 2: 147–50.
46.
LaurenceA.S.Biochemical changes following suxamethonium. Serum myoglobin, potassium and creatinine kinase changes before commencement of surgery. Anaesthesia1985; 40: 854–9.
47.
DierdorfS.F., McNieceW.L., WolfeT.M.. Effect of thiopental and succinylcholine on serum potassium concentrations in children. Anesth Analg1984; 63: 1136–8.
48.
NaguibM., FaraqH., MagbagbeolaJ.A.Effect of pre-treatment with lysine acetyl salicylate on suxamethonium-induced myalgia. Br J Anaesth1987; 59: 606–10.
49.
StoeltingR.K., PetersonC.Adverse effects of increasing succinylcholine dose following d-tubocurarine pre-treatment. Anesth Analg1975; 54: 282–8.
50.
StevensonD.E.Changes in the blood electrolytes of anaesthetized dogs caused by suxamethonium. Br J Anaesth1960; 32: 364–71.
51.
AndrewsM.M., DoroC., NolanJ., WhittakerR.Comparison of the mode of action of succinylcholine and succinylmonocholine on rat skeletal muscle after denervation. J Pharm Pharmacol1987; 39: 173–9.
52.
DayS.Plasma potassium following suxamethonium and suxethonium in normal patients with renal failure. Br J Anaesth1976; 48: 1011–5.
53.
GronertG.A., TheyeR.A.Pathophysiology of hyperkalaemia induced by succinylcholine. Anesthesiology1975; 43: 89–99.
54.
BaliI.M., DundeeJ.W., DoggartJ.R.The source of increased plasma potassium following succinylcholine. Anesth Analg1975; 54: 680–6.
55.
TammistoT., AiraksinenM.Increase of creatine kinase activity in serum as sign of muscular injury caused by intermittently administered suxamethonium during halothane anaesthesia. Br J Anaesth1966; 38: 510–4.
56.
DundeeJ.W., BaliI.M.The role of muscle trauma in the production of hyperkalaemia following suxamethonium. Br J Clin Pharm1975; 2: 376.
57.
BaliI.M., DundeeJ.W., AssafR.A.Immediate changes in plasma potassium, sodium and chloride concentrations induced by suxamethonium. Br J Anaesth1975; 47: 393–7.
58.
WisborgK., HanelHk, Viby-MogensenJ.Variations in serum potassium and serum cholinesterase activity after induction with Althesin-suxamethonium and thiopentone-suxamethonium. Acta Anaesthesiol Scand1974; 18: 237–42.
59.
DhanarajV.J., NarayanamurthyJ., SitadeviC., RaoK.M.A study of the changes in serum potassium concentration with suxamethonium using different anaesthetic agents. Br J Anaesth1975; 47: 516–9.
60.
GalT.J., MalitL.A.The influence of ketamine induction on potassium changes and fasciculations following suxamethonium. Br J Anaesth1972; 44: 1077–80.
61.
StevensonD.E.Changes caused by anaesthesia in the blood electrolytes of the dog. Br J Anaesth1960; 32: 353–63.
62.
FryE.N.Use of propranidid and lignocaine to modify the increase in serum potassium concentration following injection of suxamethonium. Br J Anaesth1978; 50: 841–3.
63.
FamewoC.E., MagbagbeolaJ.A., OgunnaikeI.A.Plasma potassium, sodium and blood sugar following etomidate and suxamethonium. Anaesthesia1979; 34: 278–80.
64.
StovnerJ., EndresenR., BjelkeE.Suxamethonium hyperkalaemia with different induction agents. Acta Anaesthesiol Scand1972; 16: 46–50.
65.
MagbageolaJ.A., AdadevohB.K., DurowojuJ.E.Influence of ether anaesthesia on suxamethonium-induced hyperkalaemia. Anaesthesia1974; 29: 429–34.
66.
RollerM.E., BreivikH., GreiderP., JonesD.J., SmithR.B.Synergistic effect of acidosis and succinylcholine-induced hyperkalaemia in spinal cord transected rats. Acta Anaesthesiol Scand1984; 28: 87–90.
67.
InabaH., OhwadaT., SatoJ., MizuguchiT., HirasawaH.Effects of salbutamol and hyperventilation on the rise in serum potassium after succinylcholine administration. Acta Anaesthesiol Scand1987; 31: 524–8.
68.
EversW., RaczG.B., LevyA.A.Changes in plasma potassium and calcium levels and in the electrocardiogram after a single dose of succinylcholine preceded by d-tubocurarine. Can Anaesth Soc J1976; 23: 383–94.
69.
StrikerT.W., MorrowA.G.Effect of succinylcholine on the level of serum potassium in man. Anesthesiology1968; 29: 214–5.
70.
KoideM., WaudB.E.Serum potassium concentrations after succinylcholine in patients with renal failure. Anesthesiology1972; 36: 142–5.
71.
GronertG.A., LambertE.H., TheyeR.A.The response of denervated skeletal muscle to succinylcholine. Anesthesiology1973; 39: 13–22.
72.
KonchigeriH.N., TayC.Influence of pancuronium on potassium efflux produced by succinylcholine. Anesth Analg1976; 55: 474–7.
73.
FamewoC.E.The influence of fazadinium on the potassium efflux produced by succinylcholine. Can Anaesth Soc J1981; 28: 463–6.
74.
MageeD.A., GallagherE.G.‘Self-taming’ of suxamethonium and plasma potassium concentration. B J Anaesth1984; 56: 977–80.
75.
AldreteJ.A., ZahlerA., AikawaJ.K.Prevention of succinylcholine induced hyperkalaemia by magnesium sulfate. Can Anaesth Soc J1970; 17: 477–84.
CollierC.B.Dantrolene and suxamethonium. Anaesthesia1979; 34: 152–8.
78.
RadnayP.A., BadolaR.P., DalsaniaA., El-GaweetE.I., DuncalfD.Prevention of suxamethonium-induced changes in serum potassium concentration by hexafluorenium. Is their combined use justified? Br J Anaesth1979; 51: 447–51.
79.
EisenbergM., BasleyS., KatzR.L.Effects of diazepam on succinylcholine-induced myalgia, potassium increase, creatine phosphokinase elevation, and relaxation. Anesth Analg1979; 58: 314–7.
80.
McCammonR.L., StoeltingR.K.Exaggerated increase in serum potassium following succinylcholine in dogs with beta blockade. Anesthesiology1984; 61: 723–5.
81.
ChatterjiS., ThindS.S., DagaS.R.Lignocaine pretreatment for suxamethonium. A clinicobiochemical study. Anaesthesia1983; 38: 867–70.
82.
ShrivastavaO.P., ChatterjiS., KachhawaS., DagaS.R.Calcium gluconate pre-treatment for prevention of succinylcholine-induced myalgia. Anesth Analg1983; 62: 59–62.
83.
SlaterR.M., McLarenI.D.Effect of salbutamol and suxamethonium on the plasma potassium concentration. Br J Anaesth1987; 59: 602–5.
84.
GoldhillD.R., MartynJ.A., HoaglinD.C.Beta-adrenoceptor blockade, alpha stimulation and changes in plasma potassium concentration after suxamethonium administration in dogs. Br J Anaesth1987; 59: 611–6.
85.
MaryniakJ.K., HendersonA.M., WoodallN.M., LimM., SimpsonJ.C.Beta-adrenoceptor blockade and suxamethonium-induced increase in plasma potassium. Anaesthesia1987; 42: 71–4.
86.
RothJ.L., NugentM., GronertG.A.Verapamil does not alter succinylcholine-induced increases in serum potassium during halothane anesthesia in normal dogs. Anesth Analg1985; 64–1202–4.
87.
BulloughJ.Intermittent suxamethonium injections. Br Med J1959; 1: 786–7.
88.
Editorial.Neuromuscular blockers in patients with burns. Lancet1988; 2: 1003–4.
89.
KimC., FukeN., MartynJ.A.J.Burn injury to rat increases nicotine acetylcholine receptors in the diaphragm. Anesthesiology1988; 68: 401–6.
90.
AxelssonJ., ThesleffS.A study of supersensitivity in denervated mammalian skeletal muscle. J Physiol1959; 149: 178–93.
91.
GronertG.A., TheyeR.A.Effect of succinylcholine on skeletal muscle with immobilization atrophy. Anesthesiology1974; 40: 268–71.
92.
LedinghamJ.G.G.Acute renal failure. In: WeatherallD.J., LedinghamJ.G.G., WarrellD.A. eds. Oxford Textbook of Medicine, 2nd edn. Oxford University Press, 1987; 18: 129.
FlemingW.B., HuestonJ.T., StubbeJ.L., VilliersJ.D.Two episodes of cardiac arrest in one week: full recovery after cardiac massage. Br J Anaesth1960; 1: 157–60.
95.
FinerB.L., NylenB.O.Cardiac arrest in the treatment of burns, and report on hypnosis as a substitute for anaesthesia. Plast Reconstr Surg1961; 27: 49–55.
96.
McCaugheyT.J.Hazards of anaesthesia for the burned child. Can Anaesth Soc J1962; 9: 220–33.
97.
BushG.H., GrahamH.A.P., LittlewoodA.H.M., ScottL.B.Danger of suxamethonium and endotracheal intubation in anaesthesia for burns. Br Med J1962; 2: 1081–5.
98.
AllanC.M., CullenW.G., GilliesD.M.M.Ventricular fibrillation in a burned boy. Can Med Assoc J1961; 85: 432–4.
99.
BelinR.P., KarleenC.I.Cardiac arrest in the burned patient following succinylcholine administration. Anesthesiology1966; 27: 516–8.
100.
StoneW.A., BeachT.P., HamelbergW.Succinylcholine-induced hyperkalaemia in dogs with transected sciatic nerves or spinal cords. Anesthesiology1970; 32: 515–20.
101.
KellyE.P.A rise in serum potassium after suxamethonium following brachial plexus injury. Anaesthesia1982; 37: 694–5.
102.
BrimV.D.Denervation sensitivity: the response to depolarising muscle relaxants. Br J Anaesth1973; 45: 222–6.
103.
JohnD.A., TobeyR.E., HomerL.D., RiceC.L.Onset of succinylcholine-induced hyperkalaemia following denervation. Anesthesiology1976; 45: 294–9.
104.
GravleeG.P.Succinylcholine-induced hyperkalaemia in a patient with Parkinson's disease. Anesth Analg1980; 59: 444–6.
SeayA.R., ZeiterF.A., ThompsonJ.A.Cardiac arrest during anaesthesia in Duchenne muscular dystrophy. J Paediatr1978; 93: 88–90.
107.
WattersG., KarpartiG., KaplanB.Post-anaesthetic augmentation of muscular damage as a presenting sign in three patients with Duchenne muscular dystrophy. Can J Neurol Sci1977; 4: 228.
DierdorfS.F., McNieceW.L., RaoC.C., WolfeT.M., MeansL.J.Failure of succinylcholine to alter plasma potassium in children with myelomeningicoele. Anesthesiology1986; 64: 272–3.
112.
DierdorfS.F., McNieceW.L., RaoC.C.. Effect of succinylcholine on plasma potassium in children with cerebral palsy. Anesthesiology1985; 62: 88–90.
113.
MartynJ.A.J., GoldhillD.R.Cold injury and hyperkalaemia. Anaesthesia1987; 42: 561.
114.
KohlshutterB., BaurH., RothF.Suxamethonium-induced hyperkalaemia in patients with severe abdominal infection. Br J Anaesth1976; 48: 557–61.
115.
KhanT.Z., KhanR.M.Changes in serum potassium following succinylcholine in patients with infections. Anesth Analg1983; 62: 327–31.
116.
HortonW.A., FergussonN.V.Hyperkalaemia and cardiac arrest after the use of suxamethonium in intensive care. Anaesthesia1988; 43: 890–1.
117.
MazzeR.I., DunbarR.W.Intralingual succinylcholine administration in children: an alternative to intravenous and intramuscular routes?Anesth Analg1968; 47: 605–15.
118.
WaltonJ.D., FarmanJ.V.Suxamethonium, potassium and renal failure. Anaesthesia1973; 28: 626–30.
119.
MillerR.D., WayW.L., HamiltonW.K., LayzerR.B.Succinylcholine-induced hyperkalaemia in patients with renal failure?Anaesthesiology1972; 36: 138–41.
120.
CookD.R., CosimiA.B.Potassium release after succinylcholine in acutely uraemic monkeys. Anesthesiology1972; 36: 297–8.
121.
CookD.R., CosimiA.B., HammondsM.W.Potassium release following administration of succinylcholine in chronically uraemic monkeys. Can Anaesth Soc J1972; 19: 634–8.
122.
PowellJ.N., GolbyM.The pattern of potassium liberation following a single dose of suxamethonium in normal and uraemic rats. Br J Anaesth1971; 43: 662–8.
123.
PowellJ.N.Suxamethonium-induced hyperkalaemia in a uraemic patient. Br J Anaesth1970; 42: 806.
124.
SlawsonK.B.Anaesthesia for the patient in renal failure. Br J Anaesth1972; 44: 277–82.
125.
MonksP.S., LumleyJ.Anaesthetic aspects of renal transplantation. Ann R Coll Surg Engl1972; 50: 354–66.
