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The optimal dose of succinylcholine for rapid sequence induction: a systematic review and meta-analysis of randomized trials.
BMC Anesthesiology 2020 March 3
BACKGROUND: The evidence base for the widely accepted standard regimen of succinylcholine for rapid sequence induction (1.0 mg kg- 1 ) remains unclear.
METHODS: We performed a systematic review and meta-analysis of randomized trials comparing any succinylcholine regimen with the standard regimen (1.0 mg kg- 1 ) and reporting on intubating conditions and/or apnoea times. Results were expressed as absolute risk differences (ARD) for dichotomous data and mean differences (MD) for continuous data.
RESULTS: We retrieved six trials with relevant data of 864 patients (ASA 1 or 2, aged 18-65 years, body mass index < 30 kg m- 2 ). Four regimens (0.3, 0.4, 0.5, 0.6 mg kg- 1 ) were compared with 1.0 mg kg- 1 in at least three trials each, and three (0.8, 1.5, 2 mg kg- 1 ) in one each. With 0.3 to 0.5 mg kg- 1 , the likelihood of excellent intubating conditions was significantly decreased (ARD - 22% to - 67%). With 0.3 and 0.4 mg kg- 1 , but not with 0.5, 0.6, 0.8, 1.5 and 2.0 mg kg- 1 , the likelihood of unacceptable intubating conditions was significantly increased (ARD + 22% and + 32%, respectively). With 2.0 mg kg- 1 , but not with 0.8 or 1.5 mg kg- 1 , the likelihood of excellent intubating conditions was significantly increased (ARD + 23%). Apnoea times were significantly shorter with regimens ≤0.8 mg kg- 1 (MD - 1.0 to - 3.4 min) but were not reported with 1.5 or 2.0 mg kg- 1 .
CONCLUSIONS: With succinylcholine regimens ≤0.5 mg kg- 1 , excellent intubating conditions are less likely and apnoea times are shorter, compared with 1 mg kg- 1 . With 0.3 and 0.4 mg kg- 1 , unacceptable intubating conditions are more common. Succinylcholine 1.5 mg kg- 1 does not produce more often excellent conditions compared with 1 mg kg- 1 , while 2.0 mg kg- 1 does, but the database with these regimens is weak and apnoea times remain unknown. Limited information size and strong statistical heterogeneity decrease the certainty of the evidence.
METHODS: We performed a systematic review and meta-analysis of randomized trials comparing any succinylcholine regimen with the standard regimen (1.0 mg kg- 1 ) and reporting on intubating conditions and/or apnoea times. Results were expressed as absolute risk differences (ARD) for dichotomous data and mean differences (MD) for continuous data.
RESULTS: We retrieved six trials with relevant data of 864 patients (ASA 1 or 2, aged 18-65 years, body mass index < 30 kg m- 2 ). Four regimens (0.3, 0.4, 0.5, 0.6 mg kg- 1 ) were compared with 1.0 mg kg- 1 in at least three trials each, and three (0.8, 1.5, 2 mg kg- 1 ) in one each. With 0.3 to 0.5 mg kg- 1 , the likelihood of excellent intubating conditions was significantly decreased (ARD - 22% to - 67%). With 0.3 and 0.4 mg kg- 1 , but not with 0.5, 0.6, 0.8, 1.5 and 2.0 mg kg- 1 , the likelihood of unacceptable intubating conditions was significantly increased (ARD + 22% and + 32%, respectively). With 2.0 mg kg- 1 , but not with 0.8 or 1.5 mg kg- 1 , the likelihood of excellent intubating conditions was significantly increased (ARD + 23%). Apnoea times were significantly shorter with regimens ≤0.8 mg kg- 1 (MD - 1.0 to - 3.4 min) but were not reported with 1.5 or 2.0 mg kg- 1 .
CONCLUSIONS: With succinylcholine regimens ≤0.5 mg kg- 1 , excellent intubating conditions are less likely and apnoea times are shorter, compared with 1 mg kg- 1 . With 0.3 and 0.4 mg kg- 1 , unacceptable intubating conditions are more common. Succinylcholine 1.5 mg kg- 1 does not produce more often excellent conditions compared with 1 mg kg- 1 , while 2.0 mg kg- 1 does, but the database with these regimens is weak and apnoea times remain unknown. Limited information size and strong statistical heterogeneity decrease the certainty of the evidence.
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