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Hyperkalemia (serum potassium >5.5 mEq/L) is often considered a contraindication to succinylcholine (SCh) use, even though the increase in plasma potassium after SCh administration is modest (generally <0.5 mEq/L). These investigators reviewed more than 40,000 cases of general anesthesia to identify patients who were hyperkalemic before induction with SCh.
Thirty-eight adults and children were identified. Plasma potassium levels ranged from 5.6 to 7.6 mEq/L. Twelve patients had end-stage renal disease (ESRD). None of the patients had dysrhythmia or other adverse events that were attributable to a change in serum potassium levels. The authors calculated that the maximum risk for adverse events in hyperkalemic patients who received SCh is 7.9%…