Study of Two Doses of Succinylcholine from Nigeria

Out on PubMed is this study from clinicians in Nigeria:

Modified electroconvulsive therapy in a resource-challenged setting: Comparison of two doses (0.5 mg/kg and 1 mg/kg) of suxamethonium chloride.

Aaron OI, Faponle AF, Bolaji BO, Mosaku SK, Adenekan AT, Oginni OA.Saudi J Anaesth. 2020 Oct-Dec;14(4):487-492. doi: 10.4103/sja.SJA_147_20. Epub 2020 Sep 24.PMID: 33447191

The abstract is copied below:

Background: Suxamethonium has been shown to have a superior modification of the convulsion associated with ECT compared to other muscle relaxants. The dosage of suxamethonium used in ECT varies widely based on the experiences of practitioners. The study aimed to determine and compare the effectiveness and side effect profile of 0.5 mg/kg and 1 mg/kg in modified ECT.
Subjects and Methods: This was a prospective randomized crossover study, comparing the effects of suxamethonium at a dose of 0.5 mg/kg, and 1.0 mg/kg in 27 patients who had a total of 54 sessions of modified ECT. The primary outcome parameters were quality of convulsion and onset and duration of apnoea. The secondary outcome parameters were hemodynamic variables, arterial oxygen saturation, delayed recovery, muscle pain, vomiting, headache, prolonged convulsion, and serum potassium. Data collected were entered into proforma and analyzed using Statistical Package for Social Sciences (SPSS) version 17.0. Parametric variables are presented as means and standard deviations while non-parametric variables are presented as frequencies and percentages. The level of significance (P-value) was considered at 0.05.
Results: Sixteen patients (59%) had acceptable convulsion modification with 0.5 mg/kg suxamethonium compared to 23 patients (85%) with the use of 1.0 mg/kg suxamethonium (P = 0.016). There was no statistically significant difference in the duration of convulsion, the onset of apnoea, and the duration of apnoea with the two doses. Changes in heart rate, blood pressure, arterial oxygen saturation, and serum potassium level that accompany the mECT were comparable with the two doses of suxamethonium studied.
Conclusions: A better modification of convulsion with comparable hemodynamic and side effect profile is achieved during mECT with the use of 1.0 mg/kg suxamethonium compared to 0.5 mg/kg.

Keywords: Electroconvulsive therapy; seizure modification; suxamethonium chloride

And figures from the text:

This report comes to the obvious conclusion that a higher dose of succinylcholine modifies the motor seizure better. It seems like a carefully conducted study that may have needed to be done to show that a standard dose should be used, even in resource-strapped settings. Again, we note the preponderance of patients with schizophrenia as the indication for ECT.

The references are very limited, omitting many of the other studies showing that about 1mg/kg, or slightly lower, is an appropriate dose for succinylcholine in ECT.

While it is not necessary to read this paper in full (the abstract is fairly complete and informative), I offer kudos to our Nigerian colleagues for this contribution to the literature.