Succinylcholine in the Intensive Care Unit

University of California, Davis, California. gagronert@ucdavis.eduIn Reply:—Biccard and Hughes factually support their proposal. Overall evaluation implies that succinylcholine should not be used in intensive care unit patients with bed rest beyond 1 week (disuse atrophy aggravated by other factors) or with administration of nondepolarizers beyond 5 days (pharmacologic denervation).Biccard and Hughes graciously ignored my failure to cite their reference. 1Other work not cited further emphasizes the risk of altered skeletal muscle leading to sudden unexpected cardiac arrest at induction of anesthesia:Inclusion of the succinylcholine-related data 1–3in table 1 of my article 5adds one denervation patient who died, 2two surviving intensive care unit patients, 1and three surviving miscellaneous category patients. 3New totals for the category of receptor up-regulation: 70 patients, 78 arrests, 9 deaths, and mortality now 11.5% rather than 11.1%. Hopefully, this mortality can be avoided.