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REPLY

Akinori Yamazaki, MD^*, Hiroyuki Kinoshita, MD, PhD, Manabu Shimogai, MD^*, Keisuke Fujii, MD^*, Katsutoshi Nakahata, MD, Yasuo Hironaka, MD^*, Hiroshi Iranami, MD^* and Yoshio Hatano, MD, PhD

^* Japanese Red Cross Society Wakayama Medical Center;
Wakayama Medical University, Wakayama, Japan, E-mail: hkinoshi{at}pd5.so-net.ne.jp

We appreciate Chawla et al.’s interest in our article. Succinylcholine may be associated with an increase in heart rate, corresponding with elevation of plasma nor-epinephrine.¹ Indeed, in the control group in our study, heart rate was significantly elevated one minute after intubation.² Therefore, it is unlikely that succinylcholine augmented the negative chronotropic response observed in the landiolol groups. However, since we administered vecuronium immediately after intubation, we cannot exclude the possibility that this drug may have attenuated catecholamine release after succinylcholine, resulting in smaller changes in heart rate and blood pressure.^1,2 We recognize that perioperative ß–blocker administration to obtain perioperative hemodynamic optimization must be done selectively. The use of short-acting ß–blockers including landiolol, may confer specific benefits in the setting of brief, but intense periods of autonomic stimulation in patients with coronary artery disease.

References

1 Oshita S, Denda S, Fujiwara Y, Takeshita H, Kosaka F. Pretreatment with d-tubocurarine, vecuronium, and pancuronium attenuates succinylcholine-induced increases in plasma norepinephrine concentrations in humans. Anesth Analg 1991; 72: 84–8.[Abstract/Free Full Text]

2 Yamazaki A, Kinoshita H, Shimogai M, et al. Landiolol attenuates tachycardia in response to endotracheal intubation without affecting blood pressure. Can J Anesth 2005; 52: 254–7.[Abstract/Free Full Text]

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