Defasciculating dose before Succs?

[Bluebolt]

So in lecture, we're educated that 10mg of Roc is to be given before your induction dose of Succinylcholine to block post op myalgia. I thought this was a non-negotiable thing, similar to giving Robinul before Neostigmine. I've come across a couple people during rotations that request I don't use a defasciculating dose. This seems cruel to me but my experience is limited to mostly theory at this point. I understand they like to see the physical fasciculations but is that necessary and is it worth the pain post op? Have you actually visited them post op and heard them complain of myalgia?

I'm just interested in what more experienced CRNAs think about this.

[macanes, BSN, MSN, DNP, CRNA]

I agree and don't usually give a defasculating dose before my SCh, when I use it. Several points: (1) the defasc. dose needs to be on board for a few minutes, so I should give it when I get the pt on the table, (2) I use 5mg roc, if I use it at all -- still can see respiratory compromise prior to induction with this, and certainly if you let 10mg roc set up for a few minutes, (3) suggamadex is a game changer (but does have SEs at dose required to reverse a full RSI dose of roc), thus I use SCh much more rarely (usually in places that don't have Sugg), (4) I always, always mix my glyco with my neostig -- not because of onset, but because it removes the possibility of a major error (i.e., give the neostig. and forget/get distracted/whatever and not give the glyco in a timely fashion = bradycardia, SLUDE, profound problems), which I prefer to avoid.

Sorry about the run-on sentence. Just my $0.02.

God bless