A retrospective observational study on use of defasciculating dose of non-depolarising muscle relaxant before rapid sequence induction with succinylcholine in pandemic era: Our experience

Abstract

Background: In the pressing times of Covid pandemic, it was necessary to adopt safe anaesthesia practices for both, the patient and healthcare personnel. Rapid sequence induction and intubation (RSII) was the recommended practice for providing anaesthesia. Succinylcholine was neuromuscular blocking drug (NMBD) of choice for RSII, in our facility. Any inadvertent movement due to succinylcholine induced fasciculations can pose the risk of breach in airway barrier, injury to the patient and add to the concerns of airway handling personnel in sparsely staffed operation theatres. In this retrospective observational study, we outline the profile and our experience with consistent use of defasciculating dose of non-depolarising muscle relaxant (NDMR) before RSII. Methods: The data of patients who underwent RSII, was retrospectively analysed over a three-month period of year 2020 in Covid pandemic. The anaesthesia technique and covid precautions were based on institutional protocols. The outcome was recorded as occurrence of fasciculations and any adverse effect due to defasciculating dose of NDMR. The data was analysed using Microsoft excel. Results: Fasciculations occurred in 23 of these 116 patients (19.8%). Four patients complained of uneasiness after administration of defasciculating dose of NDMR. Conclusion: Amid concerns of minimising personnel exposure to aerosol transmitted infections and adequate patient safety, pre-curarisation with NDMRs can be adopted as a uniform practice to facilitate the tracheal intubation using RSII with succinylcholine, without clinically apparent adverse events.