Paralytic Question

Maybe some of the drugs they give increase potassium? Just guessing.

Succinylcholine raises potassium levels, may cause a lethal elevation in certain patient populations. Helps guide the decision in what relaxant to use in an emergent airway situation.

Agree with the above; succinylcholine raises (which is why many docs wont use it for patients with renal disease).

Those populations being: burn injury, prolonged immobilization, massive trauma, myopathies, paraplegia, denervation of skeletal muscle. If patient is in renal failure and the K+ is elevated already, the addition of sux can cause lethal arrythmias too.

Persons with elevated Potassium level due to renal failure do not experience an even higher potassium level when given Succinylcholine. Succinylcholine is not contraindicated in persons with renal failure, although is should be used cautiously..

Skipaway named all the problems that will increase K level even further
Acute burns or trauma within 72 hrs
prolonged immobilization
myopathies (should not be given to children)
paraplegia or any nerve damage

Thanks for clarifying this. I can recall an ICU doc who came down to the ED to check out his newly intubated patient who had a history of renal failure (I was helping the primary nurse finish a few things up such as OG, foley, etc). I happened to be the only nurse in the room at the time and the doc chewed me out for "giving" sux to his patient (even though I didn't).

I've come to find that many ED docs are reluctant to use sux in patients with renal failure, perhaps because so many of the renal patients we see come to the ED because they missed dialysis, had altered mentation, or some other serious concern. I guess it may be different if we had an electrolyte panel to go off of - or perhaps its an old-school mindset?

MOONSHINE, it is documented in several books but one I will quote that I have on hand is Anesthesia and Co-Existing Disease 4th ed which states, " Potassium release following administration of succinylcholine is not exaggerated in patients with chronic renal failure, although there is a theoretical concern that those with extensive uremic neuropathies might be at increased risk. Likewise, caution is indicated when the preop serum potassium concentration is in the high-normal range, as this finding combined with max drug induced potassium release (.5-1 mEq/L) could result in dangerous hyperkalemia" (p. 353).

Hope this helps!!!!

Rarely do I see succ. used......I usually see Rocuronium, Vec,

That can be a dangerous choice if your laryngoscopist can't place the snorkel. Especially since the FDA flushed sugammadex down the toilet. A low dose of sux will give you time to take a look down the pie hole without burning too many bridges if you do not score or worse, lose your ability to mask.