Suxamethonium is dangerous in polyneuropathy.

Abstract

Case 1?A 23-year-old woman developed weak arms and legs and diplopia during her second pregnancy. On examination she had a mild peripheral sensory disturbance, definite distal muscle weakness, and absent tendon reflexes. Cerebrospinal fluid (CSF) protein was 20 g/1. The neuropathy relapsed over the next five years until she presented with deteriorating pulmonary function and an inability to cough due to muscle weakness, for which she required artificial ventilation. She was given atropine and thiopentone to induce anaesthesia and then paralysed with suxamethonium (succinylcholine) before in? tubation. During this procedure she developed a ventricular tachycardia, which returned promptly to sinus rhythm with intravenous lignocaine and DC cardioversion. Case 2?A 42-year-old man presented with paraesthesia in the hands and feet and left-sided facial weakness. Over the next seven months his arms and legs became progressively weak, extending proximally. He was almost completely paralysed in the arms, legs, and trunk and had a peripheral sensory dis? turbance and absent reflexes. CSF protein concentration was raised at 2-84 g/1. Because he could not cough effectively and his respiratory function was deteriorating he required artificial ventilation. He was given atropine 0-3 mg, thiopentone 200 mg, and suxamethonium 75 mg intravenously before intubation. His pulse was lost immediately, and ECG monitoring showed ventricular tachycardia, which progressed to ventricular fibrillation. He was given intravenous lignocaine and cardio verted on four occasions before returning to sinus rhythm. No further arrhythmias were noted. Case 3?A 75-year-old man was admitted with a five-month history of progressive weakness of the legs. On examination he had flaccid paralysis of all muscle groups with absent tendon reflexes. CSF protein concentration was 3-2 g/1. He developed purulent sputum and a chest radiograph showed consolidation in the right lower lobe. Because he was unable to cough and blood gas concentrations were falling he was intubated, artificial