The study of pretreatment with diphenylhydantoin or D-tubocurarine on succinylcholine-induced adverse effects

Intravenous succinylcholine (SCh) is widely used as a muscle relaxant but it is often associated with adverse effects, including muscle fasciculations, postoperative myalgia, elevated serum potassium (K+) and creatine phosphokinase (CPK), etc. The present study was undertaken to evaluate the effects of pretreatment with Diphenylhydantoin (DPH) or d-Tubocurarine (d-TC) on SCh-induced adverse effects. 54 ASA I-II adult patients were randomly divided into 3 groups of 18 patients each. Four min before injection of SCh, group A received 1 ml of normal saline as a control group, group B DPH 2.5 mg kg-1 and group C d-TC 50 micrograms kg-1. Anesthesia was induced with thiopentone 3-4 mg kg-1 and then SCh was given to facilitate tracheal intubation. Anesthesia was maintained with isoflurane and nitrous oxide in oxygen. Muscle fasciculations, postoperative 24 hours myalgia, intubating conditions and levels of serum K+, CPK and DPH were recorded in every patient. All data were analyzed with Chi-Square and ANOVA tests. DPH and d-TC significantly decreased the incidence of fasciculations, whereas there were no differences regarding intubating condition, post-operative myalgia, and serum K+ among three groups. DPH concentration was 8.49 +/- 1.55 micrograms ml-1. Serum CPK was increased postoperatively in three groups. Pretreatment with DPH 2.5 mg kg-1 or d-TC 50 micrograms kg-1 effectively decreased SCh-induced fasciculations and did not affect intubating condition facilitated with SCh 1.5 mg kg-1. Nevertheless, these pretreatment did not improve postoperative myalgia and decrease serum CPK.(ABSTRACT TRUNCATED AT 250 WORDS)