{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T10:42:25Z","timestamp":1794048145935,"version":"4.8.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T00:00:00Z","timestamp":1583107200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T00:00:00Z","timestamp":1583107200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>The evidence base for the widely accepted standard regimen of succinylcholine for rapid sequence induction (1.0\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>) remains unclear.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We performed a systematic review and meta-analysis of randomized trials comparing any succinylcholine regimen with the standard regimen (1.0\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>) and reporting on intubating conditions and\/or apnoea times. Results were expressed as absolute risk differences (ARD) for dichotomous data and mean differences (MD) for continuous data.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>We retrieved six trials with relevant data of 864 patients (ASA 1 or 2, aged 18\u201365\u2009years, body mass index &lt;\u200930\u2009kg\u2009m<jats:sup>\u2212\u20092<\/jats:sup>). Four regimens (0.3, 0.4, 0.5, 0.6\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>) were compared with 1.0\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup> in at least three trials each, and three (0.8, 1.5, 2\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>) in one each. With 0.3 to 0.5\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>, the likelihood of excellent intubating conditions was significantly decreased (ARD \u2212\u200922% to \u2212\u200967%). With 0.3 and 0.4\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>, but not with 0.5, 0.6, 0.8, 1.5 and 2.0\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>, the likelihood of unacceptable intubating conditions was significantly increased (ARD +\u200922% and\u2009+\u200932%, respectively). With 2.0\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>, but not with 0.8 or 1.5\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>, the likelihood of excellent intubating conditions was significantly increased (ARD +\u200923%). Apnoea times were significantly shorter with regimens \u22640.8\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup> (MD \u2212\u20091.0 to \u2212\u20093.4\u2009min) but were not reported with 1.5 or 2.0\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>With succinylcholine regimens \u22640.5\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>, excellent intubating conditions are less likely and apnoea times are shorter, compared with 1\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>. With 0.3 and 0.4\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>, unacceptable intubating conditions are more common. Succinylcholine 1.5\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup> does not produce more often excellent conditions compared with 1\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup>, while 2.0\u2009mg\u2009kg<jats:sup>\u2212\u20091<\/jats:sup> does, but the database with these regimens is weak and apnoea times remain unknown. Limited information size and strong statistical heterogeneity decrease the certainty of the evidence.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12871-020-00968-1","type":"journal-article","created":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T19:02:51Z","timestamp":1583175771000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["The optimal dose of succinylcholine for rapid sequence induction: a systematic review and meta-analysis of randomized trials"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4943-450X","authenticated-orcid":false,"given":"Alessandro","family":"Putzu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin R.","family":"Tram\u00e8r","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim","family":"Giffa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Czarnetzki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,3,2]]},"reference":[{"key":"968_CR1","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1056\/NEJM195210162471603","volume":"247","author":"FF Foldes","year":"1952","unstructured":"Foldes FF, McNall PG, Borrego-Hinojosa JM. Succinylcholine: a new approach to muscular relaxation in anesthesiology. N Engl J Med. 1952;247:596\u2013600.","journal-title":"N Engl J Med"},{"key":"968_CR2","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1213\/ANE.0b013e31822dac35","volume":"115","author":"JM Ehrenfeld","year":"2012","unstructured":"Ehrenfeld JM, Cassedy EA, Forbes VE, Mercaldo ND, Sandberg WS. Modified rapid sequence induction and intubation. Anesth Analg. 2012;115:95\u2013101.","journal-title":"Anesth Analg"},{"key":"968_CR3","volume-title":"Miller\u2019s anesthesia","author":"RD Miller","year":"2015","unstructured":"Miller RD. Miller\u2019s anesthesia; 2015."},{"key":"968_CR4","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1097\/00000542-198809000-00009","volume":"69","author":"CE Smith","year":"1988","unstructured":"Smith CE, Donati F, Bevan DR. Dose-response curves for succinylcholine: single versus cumulative techniques. Anesthesiology. 1988;69:338\u201342.","journal-title":"Anesthesiology"},{"key":"968_CR5","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1097\/00000539-200005000-00036","volume":"90","author":"AF Kopman","year":"2000","unstructured":"Kopman AF, Klewicka MM, Neuman GG. An alternate method for estimating the dose-response relationships of neuromuscular blocking drugs. Anesth Analg. 2000;90:1191\u20137.","journal-title":"Anesth Analg"},{"key":"968_CR6","volume-title":"PRISMA group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement","author":"D Moher","year":"2009","unstructured":"Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement; 2009."},{"key":"968_CR7","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions. Version 5. The Cochrane Collaboration, 2011","author":"JP Higgins","year":"2011","unstructured":"Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5. The Cochrane Collaboration, 2011; 2011."},{"key":"968_CR8","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1111\/j.1399-6576.2007.01367.x","volume":"51","author":"C Lysakowski","year":"2007","unstructured":"Lysakowski C, Suppan L, Czarnetzki C, Tassonyi E, Tram\u00e8r MR. Impact of the intubation model on the efficacy of rocuronium during rapid sequence intubation: systematic review of randomized trials. Acta Anaesthesiol Scand. 2007;51:848\u201357.","journal-title":"Acta Anaesthesiol Scand"},{"key":"968_CR9","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1111\/j.1399-6576.2007.01352.x","volume":"51","author":"T Fuchs-Buder","year":"2007","unstructured":"Fuchs-Buder T, Claudius C, Skovgaard LT, Eriksson LI, Mirakhur RK, Viby-Mogensen J, et al. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand. 2007;51:789\u2013808.","journal-title":"Acta Anaesthesiol Scand"},{"key":"968_CR10","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/ALN.0b013e318194cac8","volume":"110","author":"LH Lundstr\u00f8m","year":"2009","unstructured":"Lundstr\u00f8m LH, M\u00f8ller AM, Rosenstock C, Astrup G, Wetterslev J. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish anesthesia database. Anesthesiology. 2009;110:266\u201374.","journal-title":"Anesthesiology."},{"key":"968_CR11","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1097\/00000539-200203000-00047","volume":"94","author":"JB Brodsky","year":"2002","unstructured":"Brodsky JB, Lemmens HJM, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesth Analg. 2002;94:732\u20136 table of contents.","journal-title":"Anesth Analg"},{"key":"968_CR12","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1097\/00000542-200508000-00027","volume":"103","author":"T Shiga","year":"2005","unstructured":"Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005;103:429\u201337.","journal-title":"Anesthesiology"},{"key":"968_CR13","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1213\/01.ane.0000194876.00551.0e","volume":"102","author":"HJM Lemmens","year":"2006","unstructured":"Lemmens HJM, Brodsky JB. The dose of succinylcholine in morbid obesity. Anesth Analg. 2006;102:438\u201342.","journal-title":"Anesth Analg"},{"key":"968_CR14","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/S0034-9356(09)70313-5","volume":"56","author":"MCS de Almeida","year":"2009","unstructured":"de Almeida MCS, Pederneiras SG, Chiaroni S, de Souza L. Locks G de F. [evaluation of tracheal intubation conditions in morbidly obese patients: a comparison of succinylcholine and rocuronium]. Rev Esp Anestesiol Reanim. 2009;56:3\u20138.","journal-title":"Rev Esp Anestesiol Reanim"},{"key":"968_CR15","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1097\/00000542-200105000-00011","volume":"94","author":"T Heier","year":"2001","unstructured":"Heier T, Feiner JR, Lin J, Brown R, Caldwell JE. Hemoglobin desaturation after succinylcholine-induced apnea: a study of the recovery of spontaneous ventilation in healthy volunteers. Anesthesiology. 2001;94:754\u20139.","journal-title":"Anesthesiology."},{"key":"968_CR16","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.pain.2004.09.036","volume":"113","author":"N Elia","year":"2005","unstructured":"Elia N, Tram\u00e8r MR. Ketamine and postoperative pain--a quantitative systematic review of randomised trials. Pain. 2005;113:61\u201370.","journal-title":"Pain"},{"key":"968_CR17","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1111\/j.1365-2044.1991.tb09595.x","volume":"46","author":"KG Stewart","year":"1991","unstructured":"Stewart KG, Hopkins PM, Dean SG. Comparison of high and low doses of suxamethonium. Anaesthesia. 1991;46:833\u20136.","journal-title":"Anaesthesia."},{"key":"968_CR18","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1093\/bja\/74.1.31","volume":"74","author":"SM Nimmo","year":"1995","unstructured":"Nimmo SM, McCann N, Broome IJ, Robb HM. Effectiveness and sequelae of very low-dose suxamethonium for nasal intubation. Br J Anaesth. 1995;74:31\u20134.","journal-title":"Br J Anaesth"},{"key":"968_CR19","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1097\/00000542-200311000-00007","volume":"99","author":"AF Kopman","year":"2003","unstructured":"Kopman AF, Zhaku B, Lai KS. The &quot;intubating dose&quot; of succinylcholine: the effect of decreasing doses on recovery time. Anesthesiology. 2003;99:1050\u20134.","journal-title":"Anesthesiology"},{"key":"968_CR20","first-page":"401","volume":"30","author":"M Ahmad","year":"2018","unstructured":"Ahmad M, Khan NA, Furqan A. Comparing the functional outcome of different dose regimes of succinylcholine when used for rapid induction and intubation. J Ayub Med Coll Abbottabad. 2018;30:401\u20134.","journal-title":"J Ayub Med Coll Abbottabad"},{"key":"968_CR21","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1097\/00000542-200311000-00006","volume":"99","author":"M Naguib","year":"2003","unstructured":"Naguib M, Samarkandi A, Riad W, Alharby SW. Optimal dose of succinylcholine revisited. Anesthesiology. 2003;99:1045\u20139.","journal-title":"Anesthesiology"},{"key":"968_CR22","doi-asserted-by":"publisher","first-page":"1680","DOI":"10.1213\/01.ANE.0000112315.58441.50","volume":"98","author":"MI El-Orbany","year":"2004","unstructured":"El-Orbany MI, Joseph NJ, Salem MR, Klowden AJ. The neuromuscular effects and tracheal intubation conditions after small doses of succinylcholine. Anesth Analg. 2004;98:1680\u20135 table of contents.","journal-title":"Anesth Analg"},{"key":"968_CR23","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1213\/01.ANE.0000181320.88283.BE","volume":"102","author":"M Naguib","year":"2006","unstructured":"Naguib M, Samarkandi AH, El-Din ME, Abdullah K, Khaled M, Alharby SW. The dose of succinylcholine required for excellent endotracheal intubating conditions. Anesth Analg. 2006;102:151\u20135.","journal-title":"Anesth Analg"},{"key":"968_CR24","doi-asserted-by":"publisher","first-page":"139","DOI":"10.4103\/0019-5049.96309","volume":"56","author":"S Prakash","year":"2012","unstructured":"Prakash S, Barde S, Thakur P, Gogia AR, Singh R. Intubating conditions following rapid sequence induction with three doses of succinylcholine. Indian J Anaesth. 2012;56:139\u201344.","journal-title":"Indian J Anaesth"},{"key":"968_CR25","first-page":"26","volume":"5","author":"S Taxak","year":"2013","unstructured":"Taxak S, Singh T, Anand A, Lallar K. A study to reexamine the dose of succinylcholine to provide optimal intubating conditions. Int J Pharm Pharm Sci. 2013;5:26\u20139.","journal-title":"Int J Pharm Pharm Sci"},{"key":"968_CR26","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1016\/j.jclinane.2014.03.014","volume":"26","author":"L-L Luo","year":"2014","unstructured":"Luo L-L, Huang W, Zhou L-X, Wang J, Xu L, Li P. Optimal dose of succinylcholine for tracheal intubation in patients during inhalation induction with sevoflurane: a randomized controlled trial. J Clin Anesth. 2014;26:557\u201362.","journal-title":"J Clin Anesth"}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-020-00968-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12871-020-00968-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-020-00968-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T00:07:59Z","timestamp":1614643679000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcanesthesiol.biomedcentral.com\/articles\/10.1186\/s12871-020-00968-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,2]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["968"],"URL":"https:\/\/doi.org\/10.1186\/s12871-020-00968-1","relation":{},"ISSN":["1471-2253"],"issn-type":[{"value":"1471-2253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,2]]},"assertion":[{"value":"9 December 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 February 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 March 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"not applicable.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests. Alessandro Putzu is an Associate Editor of BMC anaesthesiology.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"54"}}