Masters Theses

Date of Award

12-2003

Degree Type

Thesis

Degree Name

Master of Science in Nursing

Major

Nursing

Major Professor

John Preston

Abstract

The purpose of this pilot study was to determine the feasibility of conducting a full study comparing the differential effects of pre-treatment with atracurium, pretreatment with lidocaine, and pre-treatment with atracurium and lidocaine on the severity of fasciculations in patients who received succinylcholine. The research question under examination was: will there be any difference in the observed severity of fasciculation in subjects receiving succinylcholine who also receive one of three pharmacological regimens consisting of either lidocaine, atracurium, or lidocaine and atracurium in combination? Since the date that d-tubocuraine became commercially unavailable, no alternative pharmaceutical agent has been identified in the published literature as an optimal medication, either by dose or regimen, to prevent the occurrence or decrease the severity of fasciculations, following the administration of the depolarizing muscle relaxant succinylcholine. Muscle fasciculations have been associated with myalgia, as well as increases in intragastric, intracranial, and intraocular pressure. The bulk of investigation in this area, to date, has focused on the use of the non-depolarizing muscle relaxants rocuronium and atracurium. These muscle relaxants have been used alone and in combination with the local anesthetic, lidocaine, as a pretreatment prior to the administration of succinylcholine. All three of these medications (rocuronium, atracurium, and lidocaine) have demonstrated effectiveness at decreasing fasciculations when administered alone and in combination. No specific dosing schema, however, has been universally demonstrated to be most effective in decreasing or eliminating fasciculations in association with succinylcholine use. The study was a randomized, double blinded, quasi-experimental research design. The researcher approached subjects from the daily operating room schedule at a 600-bed Level I Trauma Center in the Southeastern United States who met all inclusion criteria and no exclusion criteria for participation. The population studied was limited to patients undergoing laparoscopic surgery, with an ASA physical status of I or II, between the ages of 18-50, with a BMI between 18-30. The measurement instrument selected to measure fasciculation was a four-point scale called the Observers Assessment of Fasciculation Scale. Results of this pilot study showed that 1.5mg/kg of lidocaine was able to prevent fasciculations in 75% of subjects, 0.05mg/kg of atracurium to prevent fasciculations in 40% of patients, and their combination to prevent fasciculation in 60% of subjects. However, all three groups were effective at limiting observed fasciculations to a score of 1 on the instrument utilized. It is recommended that this study should be replicated utilizing a larger population because the relative ease of subject access and the considerable degree of clinical significance found as a result of the conduction of the study. Further more, it appears that this pilot study allowed only for the possibility that smokers may be more likely to fasciculate than non-smokers, regardless of any of the pretreatment regimens used for this pilot study. This finding should be investigated in great depth in future studies.

Download
Files over 3MB may be slow to open. For best results, right-click and select "save as..."

Share

COinS