1. can be severe and fatal in select patient
- Occurs more often in patients with: Burns, severe muscle trauma, upper or lower motor neuron denervation and prolonged ICU care
2. This causes upregulation of the nicotinic acetylcholine receptors which results in, not only an increase in their density, but also they spread over the muscle surface outside the motor endplate area.
3.There is a change in the subunit type
4. This is called denervation supersensitivity
5. When the NMJ is exposed to succinylcholine, more ion channels become available to release K during depolarization
6. When large muscle groups are involved, there can be a massive efflux of K ions from the muscle cells causing marked hyperkalemia.
7. This precipitates severe cardia events including cardiac arrest
8. Be careful with heart failure patients on digoxin or diuretics
9. Limits its use primarily to short term procedures
10. Malignant hyperthermia: triggered most often by a combination of anesthetics and succinylcholine
11. Excessive calcium release from the SR
12. Treat symptomatically and with dantrolene