Sux

Many surgeries require some form of muscle relaxation or paralysis. For example, when a surgeon works on a vocal cord, it is imperative that the vocal cord does not move inadvertently, and in many abdominal surgeries, tensing of the abdominal muscles makes the surgery much more difficult. Broadly speaking, muscle relaxants fall under two categories, the fast-acting short-lived succinylcholine (shown above) and the longer acting non-depolarizing agents. We almost exclusively use succinylcholine for intubation only, and one of the long-acting drugs for surgical relaxation. But in some cases where absolute paralysis is required but the surgery is very short (for example, a vocal cord surgery), neither is ideal. Succinylcholine achieves the best conditions but wears off too quickly. Rocuronium or vecuronium lasts too long. Thus, I got to try a fairly arcane technique, the succinylcholine infusion. Continuous succinylcholine drips were popular before the advent of long-acting nondepolarizing agents. Indeed, when I did a literature search, the articles that came up were from the 1980s (a more recent article in 2004 was published in Poultry Science). Nevertheless, the technique, though old, still works quite well in carefully chosen cases, and so I got to employ a seldom-used technique in anesthesia.

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