United States of America. The manufacturer of the neuromuscular blocking agent, suxamethonium chloride (succinylcholine, SucostrinR: Bristol-Myers Squibb), has called attention to two life-threating events that may occur with its use:

. Cardiac arrest in children and adolescents. Several reports have been received of cardiac arrest following administration of suxamethonium chloride to apparently healthy children and adolescents who were subsequently found to have undiagnosed myopathies. A non-polarizing neuromuscular blocking drug should be used for routine elective surgery in these patients.

. Hyperkalaemia. Except when used for emergency tracheal intubation or in instances where immediate securing of the airway is necessary, suxamethonium chloride is contraindicated in patients after the acute phase of injury following major burns, multiple trauma, extensive denervation of the skeletal muscle, or upper motor neuron injury because administration to such individuals may result in severe hyperkalaemia, which may lead to cardiac arrest. The risk of hyperkalaemia in these patients increases over time and usually peaks at 7 to 10 days after the injury, depending on the extent and location of the injury. The precise time of onset and the duration of the risk period are not known.

[See also Pharmaceuticals Newsletter No. 3, March 1995]

Reference: FDA Medical Bulletin Vol. 27, No.2, Summer 1997.

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