Does Hemoglobine Level Play a Role in Metabolism of Succinylcholine

Abstract

Butyrylcholinesterase (BCHE) deficiency, several drugs or administration of high doses of succinylcholine (SCh) are well known reasons for prolonged succinylcholine clearance. The goal of this study was to investigate the relationship between hemoglobine (Hb) levels and SCh metabolism for the parturients undergoing cesarean sections. One hundred and twenty patients were randomized into three groups (n=40). In Group 1, the Hb levels of the patients were between 9-11 g dL–1. In Group 2, the levels were between 11 g dL–1 and 13 g dL–1. Finally in Group 3, the Hb levels of the patients were between 13-15 g dL–1. The BChE levels, Hb levels, the time for recovery of neuromuscular function were compared between groups. Group demographics were similar. There was no significant difference between Groups 1 and 2 regarding their drug elimination time (p>0.05). The recovery of neuromuscular functions was significantly faster in Group 3 (p<0.05). The results of our study suggest that anemia may cause prolonged SCh-induced paralysis and apnea for the patients undergoing cesarean section.

Keywords

• Succinylcholine, cesarean, hemoglobine, butyrylcholinesterase

Hemoglobin Düzeyi Süksinilkolin Metabolizmasında Rol Oynar mı?

Öz

Butiril kolinesteraz (BChE) eksikliği, çeşitli ilaçlar veya süksinilkolinin (SCh) yüksek dozda uygulanması uzamış süksinilkolin klirensinin iyi bilinen nedenlerindendir. Bu çalışmanın amacı sezeryan operasyonu geçiren gebelerde hemoglobin (Hb) düzeyleri ve SCh metabolizması arasındaki ilişkiyi araştırmaktır. Yüz yirmi hasta 3 farklı gruba (n=40) randomize edildi. Grup 1’e Hb düzeyi 9-11 g dL–1 arasındaki hastalar, Grup 2’ye 11 ile 13 g dL–1 arasında Hb düzeyi bulunan hastalar, Grup 3’e ise Hb düzeyi 13-15 g dL–1 arasında olan hastalar dahil edildi. Gruplar arasında BChE, Hb düzeyleri ve nöromüsküler fonksiyon geri dönüş zamanları karşılaştırıldı. Grupların demografik özellikleri benzerdi. Grup 1 ve 2’deki hastalar arasında ilaç eliminasyon zamanı bakımından anlamlı bir fark yoktu (p>0.05). Nöromüsküler fonksiyonların geri dönüşü Grup 3’de anlamlı olarak daha hızlıydı (p

Anahtar Kelimeler

• Çocuk hasta, üreter taşı, üreterolitiyazis, üreteroskopi, devlet hastanesi

References

1. Gudzenko V, Bittner EA, SChmidt UH. Emergency airway management. Respir Care 2010;55:1026-1035.
2. Sharp LM, Levy DM. Rapid sequence induction in obstetrics revisited. Curr Opin Anaesthesiol 2009;22:357-361.
3. Abu-Halaweh SA, Massad IM, Abu-Ali HM, Badran IZ, Barazangi BA, Ramsay MA. Rapid sequence induction and intubation with 1 mg/kg rocuronium bromide in cesarean section, comparison with suxamethonium. Saudi Med J 2007;28:1393-1396.
4. El-Orbany M, Connolly LA. Rapid sequence induction and intubation: current controversy. Anesth Analg 2010;110:1318-1325.
5. Panhuizen IF, Snoeck MM, Levano S, Girard T. Prolonged Neuromuscular Blockade Following Succinylcholine Administration to a Patient with a Reduced Butyrylcholinesterase Activity. Case Report Med (http://dx.doi.org/10.1155/2010/472389)
6. Ninan S, Jeslin L, Saravanan PA, Kumar K. Succinylcholine relaxant: Anaesthesiologist not relaxed! Indian J Anaesth 2010;54:71-72.
7. Zencirci B. Pseudocholinesterase enzyme deficiency: a case series and review of the literature. Cases J 2009;2:9148.
8. Kaya K, Günaydın B, Ergün MA, Bukan N. Türk popülasyonunda gebe olan ve olmayanlarda pseudokolinesteraz gen asp70gly mutasyonunun enzim düzeyleri ile araştırılması. Anestezi Dergisi 2013;21:157-159.

9. Nasseri K, Arastheh MT, Shami S. Pretreatment with remifentanil is associated with less succinylcholineinduced fasciculation. East J Anesthesiol 2010;20:515519.
10. Orebaugh SL. Succinylcholine: adverse effects and alternatives in emergency medicine. Am J Emerg Med. 1999 Nov;17(7):715-721.
11. Fleming B, McCollough M, Henderson SO. Atropine should be administered before succinylcholine for neonatal and pediatric intubation. CJEM 2005;7:114-117.
12. Allen TK, Habib AS, Dear GL, White W, Lubarsky DA, Gan TJ. How much are patients willing to pay to avoid postoperative muscle pain associated with succinylcholine? J Clin Anesth 2007;19:601-608.
13. Chambers D, Paulden M, Paton F, et al. Sugammadex for reversal of neuromuscular block after rapid sequence intubation: a systematic review and economic assessment. Br J Anaesth 2010;105:568-575.
14. Sparr HJ, Jöhr M. Succinylcholine-update. Anaesthesist 2002;51:565-575.
15. Arias L, O'Brien JJ, Kimball JN. Electroconvulsive therapy- and succinylcholine-related asystole. J ECT 2009;25:144.
16. Baumann A, Studnicska D, Audibert G, et al. Refractory anaphylactic cardiac arrest after succinylcholine administration. Anesth Analg 2009;109:137-140.
17. Kinsella SM, Girgirah K, Scrutton MJ. Rapid sequence spinal anaesthesia for category-1 urgency caesarean section: a case series. Anaesthesia 2010;65:664-669.
18. Sanz P, Rodriguez-Vicente MC, Diaz D, Repetto J, Repetto M. Red blood cell and total blood acetylcholinesterase and plasma pseudocholinesterase in humans: observed variances. J Toxicol Clin Toxicol 1999;29:81-90.
19. O. Karcioglu. Dilemma In Rapid Sequence Intubation: Succinylcholine vs. Rocuronium. The Internet Journal of Emergency and Intensive Care Medicine 2003;7:1.
20. Soliday FK, Conley YP, Henker R. Pseudocholinesterase deficiency: a comprehensive review of genetic, acquired, and drug influences. AANA J 2010;78:313-320.
21. Lurie S, Sadan O, Oron G, et al. Reduced pseudocholinesterase activity in patients with HELLP syndrome. Reprod Sci 2007;14:192-196.
22. Davis L, Britten JJ, Morgan M. Cholinesterase. Its significance in anaesthetic practice. Anaesthesia 1997;52:244-260.
23. González HMC, Casillas IN, Erives QG, Reza LS, Sanín ALH, Levario CM. Acetylcholinesterase activity during pregnancy and in the newborn. Ginecol Obstet Mex 2000; 68:231-235.
24. Richalet JP, Letournel M, Souberbielle JC. Effects of high altitude hypoxia on the hormonal response to hypothalamic factors. Am J Physiol Regul Integr Comp Physiol 2010;299:R1685-R1692.