Embarrassing anesthesia question that I really should know

  1. Can anybody currently viewing tell me the correct spelling of "besiculation?" or "basiculation?" For years I thought it started with a "V!!" I can't even seem to get my spelling close enough to search for it in spellcheck or in the archives on this BB!!
    Last edit by stevierae on Apr 28, '04
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  2. 17 Comments

  3. by   Gump
    I have heard of two examples that the term vessiculation is used for.
    1. lesions of leukocytoclastic vasculitis
    2. formation of bubbles due to depressuriazation (gas becomes less soluable)
    I have no idea what bessiculation is though.
  4. by   stevierae
    Quote from Gump
    I have heard of two examples that the term vessiculation is used for.
    1. lesions of leukocytoclastic vasculitis
    2. formation of bubbles due to depressuriazation (gas becomes less soluable)
    I have no idea what bessiculation is though.
    During induction of general anesthesia, and I believe it may be secondary to the effects of succinylcholine, the patient begins to tremble, and often, if her arms are not lightly restrained, she will flail her arms up a bit and even off the armboards. I have seen it many times as an OR nurse--I just cannot get the spelling correct. I looked under "the 4 Stages of Anesthesia" but nothing comes up. Maybe I can find it under "succinylcholine" while hoping someone responds. Thanks, everyone.
  5. by   kdst
    Do you mean fasciculation as in muscle fasciculations when succs wears off?
    Last edit by kdst on Apr 28, '04
  6. by   stevierae
    Quote from kdst
    Do you mean fasiculation as in muscle fasiculations when succs wears off?
    That's the word I am looking for, and thank you. I guess it DOES start with an F, as I always thought. I was so desperate (I need to email a STAT report, and don't want to submit it with a misspelled word) I called an anesthesiologist colleague long distance and had them put me directly through to his room. He answered at the same time your post came up. I have always noticed the action during induction, after the administration of succinylcholine.

    Thank you again for responding.
    Last edit by stevierae on Apr 29, '04
  7. by   kdst
    Quote from stevierae
    That's it, and thank you. I guess it DOES start with an F, as I always thought. I was so desperate (I need to email a STAT report, and don't want to submit it with a misspelled word) I called an anesthesiologist colleague long distance and had them put me directly through to his room. He answered at the same time your post came up.

    Thank you again for responding.
    yikes! i did originally spell it wrong. it is fasciculation. then i edited the post to spell it right. hope you get this before you write the report.
  8. by   gaspassah
    it's actually the onset of succs. fasciculations are the depolarizing of muscle fibers after administration of succs. when the fasciculations are complete the patient has maximal dose dependant paralysis.
    succs' molecular shape is 2 acetylcholine molecules connected. normally it takes 2 acetycholine molecules to activate a cell membrane and cause a muscle fiber to contract. the rapid metabolism of succs is due to plasma cholinesterase, the same enzyme that breaks down the body's endogenous acetycholine.
    hope this helps.
  9. by   Passin' Gas
    Acetylcholinesterase metabolizes acetylcholine in the synaptic cleft into choline and acetate. Choline is reuptaken into the presynaptic neuron and reutilized. Succinylcholine terminates its action by diffusion away from the neuromuscular junction and is metabolized in the plasma by plasma cholinesterase.
  10. by   jbro
    gaspassah and passin' gas, it look like ya'll have been doing your homework, studying for final's as well as me? if so good luck, one more week until a much needed break. gaspassah what school are you going to, i'm from lafayette, just curious?
  11. by   gaspassah
    kaiser in pasadena. finished my pharm final last week.
  12. by   kdst
    hey, guys thanks for clearing up my erroneous assumption that fasciculations occurred when the drug wears off. i guess that is what i have noticed. does it not occur when it wears off too?(repolarization? is there such a thing?) please tell me you didn't know all that mechanism before you started your programs. all i know is that succs is depolarizing as opposed to non-depolarizing. i hope they didn't make a mistake accepting me! reading your posts makes me feel like a dummy but i don't want to start studying until school starts. i really want to follow the advice of most people on the board and enjoy whatever time i have left of normalcy. that is the plan. think that is not a good idea? p.s. i'm not in the OR. i see it used for RSI, usually emergent.
    Last edit by kdst on Apr 29, '04
  13. by   jbro
    i didn't know anything about it before i started school, and now i'm up to my eyeballs in its kinetics, dynamics and side effects, don't worry they'll make sure you know all about it by the time your done with school
  14. by   gaspassah
    dont worry, i didnt know it till it was taught to me. the action of succs is initially you get depolarization. when the succs molecules diffuse away the patient is usually anesthetized. there is no real stimulus to cause a second depolarization, the muscles are not stimulated to fasciculate a second time. however, the patient, if not paralyzed with a non depolarizer or a nice dose of narcs, may buck on the tube or begin moving. this may be what you saw. if you get the chance, watch the tounge after sux is administered it will solidify what a fasciculation really is. individual muscle fibers firing in an uncoordinated fashion.
    also after the administration of succs, acetylcholine and succs kind of work in an agonist antagonist fashion. the succs molecules that diffuse away from the nerve terminal and are not immediately matobolized will reattach to the receptor (this is the antagonist part) and not allow a repolarization, as will excess acetylcholine. this is the mechanism of a phase II block if you give too much succs or redose too soon. if i am remembering this correctly.
    d

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