Case 91 - Succinylcholinein the patient with increased intracranial pressure

Summary

The use of succinylcholine in a patient with increased intracranial pressure (ICP) is still a controversial issue. This chapter highlights the benefits and the relative contraindications for using succinylcholine in such patients. It presents a case study of a 79-year-old female with hypertension and atrial fibrillation. The endotracheal intubation was performed using sodium pentothal and succinylcholine. After end-tidal CO2 and bilateral breath sounds were confirmed, the resident asked the anesthesiology attending whether another agent such as rocuronium should have been used due to the patient's increased ICP. Two studies have demonstrated that succinylcholine will increase ICP in humans and that this effect can be attenuated by a defasciculating dose of a nondepolarizing muscle relaxant. More recent studies have failed to demonstrate the increase in ICP. It is important to note that they also mentioned that other factors significantly contribute to increases in ICP in patients with neurologic injury.