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Administration of a second dose of succinylcholine is inappropriate in a clinical setting of tachycardia and masseter muscle rigidity following an initial dose, as it indicates malignant hyperthermia.
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Highlights the danger of administering a second dose of succinylcholine in patients developing tachycardia and masseter muscle rigidity after an initial dose, as it may indicate malignant hyperthermia.
In Reply. —Thank you for bringing the four letters to our attention. Drs Porter and McGoldrick mentioned that we erred in not discussing the second dose of succinylcholine given to the patient described in our article. We agree that we were remiss in not mentioning the important point that it is inappropriate to give a second dose of succinylcholine in a clinical setting of tachycardia and masseter muscle rigidity that follows the initial succinylcholine administration. Such a case should be considered malignant hyperthermia until proved otherwise, and the treatment should be discontinued, with careful monitoring of the patient's condition.1 However, at the time our case occurred (Oct 3, 1978), this fact was not universally appreciated. We were concerned that the 10-mg dose of succinylcholine may have been inadequate and that the rigidity was an abnormal manifestation of generalized fasciculations without relaxation and that the tachycardia was caused by the
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Dodd et al. (1982) conducted a letter in Malignant hyperthermia (n=1). Succinylcholine was evaluated. Administration of a second dose of succinylcholine is inappropriate in a clinical setting of tachycardia and masseter muscle rigidity following an initial dose, as it indicates malignant hyperthermia.
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