A COMPARISON OF THE EFFECT OF HIGH DOSE PROPOFOL, STANDARD DOSE PROPOFOL AND SODIUM THIOPENTONE IN THE PREVENTION OF SUXAMETHONIUM INDUCED FASCICULATION AND MYALGIA

  • ABBEY. ABIODUN OMOSANYA National Postgraduate Medical College of Nigeria

Abstract

Background: Suxamethonium is the most commonly used depolarizing neuromuscular agent in clinical practice for rapidly providing ideal conditions for endotracheal intubation.

Its use results in fasciculation and myalgia as part of the potential problems of suxamethonium. These problems have negative impact on the overall medical care of the patients.

Aim:  This study was a prospective double blind randomized study designed to compare the efficacy of high dose propofol, 3.5mg/kg with standard dose propofol,2mg/kg and thiopentone sodium, 5mg/kg in reducing the suxamethonium induced fasciculation and myalgia.

Methods: One hundred and five, unpremedicated, ASA l or II, aged between 16 –60 years patients who presented for elective general anaesthesia were recruited. The patients were randomized and induced with either propofol, 2mg/kg (Group P), thiopentone, 5mg/kg (Group STP) or high dose propofol,3.5mg/kg (Group HP). After baseline vital signs were taken, about 500ml of intravenous fluid (normal saline) was given.The induction agents were slowly injected over 90seconds to establish an adequate depth of anaesthesia. Tracheal intubation was facilitated with administration of suxamethonium,1mg/kg. The incidence and severity of fasciculation were recorded.

        Anaesthesia was maintained with oxygen/air/isoflurane mixture and pancuronium, 0.1mg/kg was given to facilitate mechanical ventilation. At the end of procedure, residual muscle paralysis was reversed and the trachea was extubated. All patients were assessed with respect to the following : incidence and severity of fasciculation immediately after administration of intravenous suxamethonium, complications during induction, haemodynamic variables, serum creatine phosphokinase (CPK) levels – baseline and 24hours postoperatively as well as theincidence and severity of postoperativemyalgia after 24hours

 

 

 

 

 

 

 

 

 

 

 

 

 

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Results:The demographic and clinical variables were comparable in the three groups.

The incidence of fasciculation was significantly lower in GroupHP, 25 (71.4%) followed byGroup STP, 34 (97.1%) andGroup P, 32(91.4%),(p< 0.001). Similarly, the severity of fasciculation was higher in Group STP,39% than inGroup P, 37%orin Group HP, 24.2%,

 (p = 0.034). The incidence of myalgia followed a similar trend and was,17(48.6%) inGroup STP,13(37.1%) inGroup Pand3(8.6%) inGroup HP, (p <0.001). However, the severity of myalgia was lessin Group HP, 7.4% thanin Group P, 41%orin Group STP, 52%,

 (p = 0.010).

The mean baseline CPK values were,79.80± 37.09 IU/Lin Group P, 77.54± 21.82 IU/L inGroup STP and 73.99± 39.76 IU/L inGroup HP, (p = 1.000). There was an increase in 24 hours postoperative CPK levelsin all the three groups. However, the mean 24hours postoperative CPK value was significantly lower in Group HP,100.85±46.42 IU/Lthanin Group STP, 139.66±35.73 IU/L orin Group P, 138.25±53.06IU/L, (p<0.001).

There was no correlation between incidence of fasciculation and myalgia, {r = -0.076,

(p = 0.56)}, as well as, no correlation was obtainedbetweenincidence of myalgia and increase in CPK levels,{r = 0.081, (p = 0.37)}.

The mean HR, blood pressures (SBP, DBP, MAP) for various time intervals measuredwere comparable in all the groups, with initial drop in the levels of post- induction, then peaked at intubation and subsequent gradual return to pre-induction levels. The mean SpO2was also comparable in all three groups with no significant difference,however, mean EtCO2in Group HP was significant at intubation, 2 mins post-intubation and 4 mins post- intubation but the decreasing percentage change in mean EtCO2 among the groups during these periods showed no significant difference.

Conclusion:The study has demonstrated that high dose propofol is more efficient thanstandard dose propofol and thiopentone in minimizing post suxamethonium fasciculation and myalgia, however, associated with side effects of hypotension and bradycardia.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Published
2018-09-15
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