sch in pregnancy

 Q: Succinylcholine should be given to a pregnant patient depending on total body weight? 

A) True 

B) False 

Answer: A 

Dose of succinylcholine is given based on total body weight. Interestingly, this is true for pregnant patients too. This is due to the fact that overestimation of the dose of succinylcholine causes the same level of paralysis. One of the caveat is that duration of action of succinylcholine is longer in pregnant women. Serum cholinesterase activity is 30% less in pregnant females and immediate postpartum females. 

Recommended dose in these patients is 1.0 mg/kg.

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References:

1. Guay J, Grenier Y, Varin F. Clinical pharmacokinetics of neuromuscular relaxants in pregnancy. Clin Pharmacokinet 1998; 34:483. 

2. Patanwala AE, Sakles JC. Effect of patient weight on first pass success and neuromuscular blocking agent dosing for rapid sequence intubation in the emergency department. Emerg Med J 2017; 34:739. 

3. Gyasi HK, Mohy O, Abu-Gyamphi, Naquib M. Plasma cholinesterase level in Pregnancy-effect of enzyme activity on the duration of action of succinylcholine. Middle East J Anesthesiol 1986;8:379-85. 

4. Leighton BL, Cheek TG, Gross JB, Apfelbaum JL, Shantz BB, Gutsche BB, et al. Succinylcholine pharmacodynamics in peripartum females Anesthesiology 1986;64:202-5 

5. Rasheed MA, Palaria U, Bhadani UK, Quadir A. Determination of optimal dose of succinylcholine to facilitate endotracheal intubation in pregnant females undergoing elective cesarean section. J Obstet Anaesth Crit Care 2012;2:86-91