Clinical Case Database / Category: Patient Management

Suxamethonium apnoea during electroconvulsive therapy

Publication details

Dr James Hillier MA, MBBS, FRCA, FFICM, Dr Pamela Tizzoni MBChB
Foundation Years Journal, volume 9, issue 8, p.11 (123Doc Education, London, September 2015)


This article describes a case of suxamethonium apnoea during ECT, highlighting this rare, but important adverse effect. It discusses how it is recognised, the immediate management and subsequent investigations, as well as discussing the risks of anaesthesia in remote areas.

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Dr James Hillier MA, MBBS, FRCA, FFICM (Corresponding author)

Consultant Anaesthetist
University Hospitals Bristol NHS Foundation Trust, BS2 8HW

Dr Pamela Tizzoni MBChB

North Bristol NHS Trust, BS10 5NB


1. World federation of societies of anaesthesiologists. Anaesthesia Tutorial of the week 306. Anaesthesia for electro-convulsive therapy. 2014. Anaesthesia for Electro-convulsive Therapy ECT.pdf
2. Uppal V, Dourish J, Macfarlane A. Anaesthesia for electroconvulsive therapy. British Journal of Anaesthesia. Continuing education in anaesthesia, critical care & pain. 2010, 10(6):192-196.
3. Mirzakhani H, Welch C, Eikermann M, Nozari A. Neuromuscular blocking agents for electroconvulsive therapy: a systematic review. Acta Anaesthesiologica Scandinavica. 2011;56(1):3-16.
4. Update in Anaesthesia. Suxamethonium Apnoea. http://e-safe
5. AnaesthesiaUK. Suxamethonium.
6. The Royal College of Anaesthetists. Anaesthetic services in remote sites. 2014.
7. Guidelines for the provision of anaesthetic services. Chapter 7. Anaesthesia services for care in the non-theatre environment 2015.
8. Hooten W, Rasmussen K. Effects of General Anesthetic Agents in Adults Receiving Electroconvulsive Therapy. The Journal of ECT. 2008, 24(3):208-223.
9. Lab Tests Online UK. Suxamethonium apnoea.
10. Lab Tests Online UK. Cholinesterase Test.


Conflict Of Interest

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.