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In patients with head injuries who undergo rapid sequence intubation using succinylcholine, does pretreatment with a competitive neuromuscular blocking agent improve outcome? A literature review
  1. M Clancy1,
  2. S Halford1,
  3. R Walls2,
  4. M Murphy3
  1. 1Emergency Department, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
  2. 2Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3Departments of Emergency Medicine and Anaesthesiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
  1. Correspondence to: Mr Clancy (clancm{at}


A literature search was undertaken for evidence of the effect of succinylcholine (SCH) on the intracranial pressure (ICP) of patients with acute brain injury and whether pretreatment with a defasciculating dose of competitive neuromuscular blocker is beneficial in this patient group. The authors could find no definitive evidence that SCH caused a rise in ICP in patients with brain injury. However, these studies were often weak and small. For those patients suffering acute traumatic brain injury the authors could find no studies that investigated the issue of pretreatment with defasciculating doses of competitive neuromuscular blockers and their effect on ICP in patients given SCH. There is level 2 evidence that SCH caused an increase in ICP for patients undergoing neurosurgery for brain tumours with elective anaesthesia and that pretreatment with defasciculating doses of neuromuscular blockers reduced such increases. It is unknown if this affects neurological outcome for this patient group.

  • anaesthesia
  • neuromuscular blocking agent

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  • Contributors

    MC initiated the study, appraised the literature, wrote the paper and is the guarantor. SH undertook the literature search and appraised the literature. RW and MM discussed core ideas and contributed to the writing of the paper.