Succinylcholine

For readers of this who are not anesthesiologists, succinylcholine (Sux to its many friends) is a very basic standard anesthesia drug, especially useful in emergency situations when you need 100% muscle relaxation very quickly.



The problem is that Rwanda has apparently run out of it! I've had several emails about this over the last few weeks, begging me to bring some with me. There may still be a few ampoules left in the country, but people are guarding their secret stashes of any remaining succinylcholine.



How bad is it to do anesthesia without Sux? Well, one time I went to do private work in a Toronto cosmetic clinic and they told me they had none. I was about to explain that I would not work without it being available should I need it in an emergency. I was quite prepared to cancel the whole list, give up a day's pay and go home if they could not find the drug. Turns out it was all a misunderstanding, and the drug was safely tucked away in a refrigerator!



In Rwanda, they have been working without it for at least five weeks to my knowledge, with no end in sight.



Even in Canada, its not unknown for anesthetic drugs to be unavailable. All pharmaceutical companies care about is making money. Anesthesia drugs are made in small volumes and are not very expensive, so they do not contribute much to the bottom line. It is no big deal for a company to give up making a drug, either permanently or while they fix up a problem on the production line. But it can be a huge problem for anesthesiologists, who want to use the drugs they are most familiar with and have found the most useful. In this situation pharmacy works overtime to find another supplier, and usually a reserve supply can be found. Sometimes we have to do extra paperwork to justify the use of scarce drugs on particular patients. Eventually the situation is resolved and life goes back to normal. So its disturbing to find that an essential drug has been missing for so long. I don't know yet if its a sign that safe anesthesia is not a priority for the country, if the relevant officials are asleep at their desks, or wether there are genuine reasons for the problem to continue so long.



Sux is not the easiest thing to transport halfway around the world. It is a liquid in glass ampoules. It is also deadly poisonous: five mls would kill you in five minutes if there was not an anesthesiologist standing by to assist you to breathe after the drug had paralysed you.



I heard about a powdered form of the drug, but it turns out that this is only available by ordering from suppliers in China over the internet. I was not prepared to take personal responsibilty for importing Chinese pharmaceuticals into Africa. In the end I found a small supply of regular liquid Sux which I will pack in a freezer bag and take to Rwanda with me. It is, at least, more than I will need for the next four weeks. With luck it will last until propoer supplies are re-established.