Inadvertent injection of succinylcholine as an epidural test dose

• Main Authors: Chryssa Pourzitaki, Georgia Tsaousi, Helena Logotheti, Ekaterini Amaniti
• Format: Article
• Language: English
• Published: Sociedade Brasileira de Anestesiologia
• Series: Revista Brasileira de Anestesiologia
• Subjects: Succinylcholine; Epidural administration; Accidental; Neuromuscular blocking agents; Fasciculations; Diazepam
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942017000400411&lng=en&tlng=en

Abstract Background and objectives: Epidural action of neuromuscular blocking agents could be explained under the light of their physicochemical characteristics and epidural space properties. In the literature there are few cases of accidental neuromuscular agent's epidural administration, manifesting mainly with neuromuscular blockade institution or fasciculations. Case report: We report a case of accidental succinylcholine administration as an epidural test dose, in a female patient undergoing scheduled laparotomy, under combined general and epidural anesthesia. Approximately 2 min after the succinylcholine injection the patient complained for shortness of breath, while mild fasciculations appeared in her trunk and face, managed by immediate general anesthesia institution. With the exception of a relatively longer duration of neuromuscular blockade compared with intravenous administration, no neurological or cardiovascular sequelae or other symptoms of local or systemic toxicity were observed. Conclusions: Oral administration of diazepam seems to lessen the adverse effects from accidental epidural administration of succinylcholine. The meticulous and discriminative labeling of syringes, as well as keeping persistent cautions during all anesthesia procedures remains of crucial importance.