Efficacy and safety of non-opioid combined intravenous anesthesia in elderly patients undergoing short daytime surgeries: A randomized controlled trial

Start Date20 May 2025

Sponsor / Collaborator-

NCT06772727

/ RecruitingPhase 4IIT

Comparison of Hemodynamic Effect of Lidocaine-based Versus Opioid-based Induction of Anesthesia in Emergency Laparotomy: a Randomized Controlled Trial.

The primary role of anesthesia is to provide unconsciousness, amnesia, immobility, and pain control. Other important roles include maintaining stable vital signs and tissue perfusion, preventing and management of organ failure.
Emergency laparotomy represents a major surgical procedure which is usually performed in patients with acute and chronic comorbidities and is associated with several surgical and medical complications with post-induction hypotension being one of the common and serious complication. Thus, it is essential to provide a balanced and safe protocol for anesthesia which maintains adequate hypnosis and antinociception besides vital stability and adequate perfusion.
Opioid drugs are commonly used within the context of balanced general anesthesia primarily for their antinociceptive effects. Opioid drugs had been a basic component of perioperative care for providing analgesia and decreasing the requirements of other hypnotic drugs. However, there are several short- and long-term adverse effects for opioid drugs such as pruritus, postoperative nausea and vomiting, respiratory depression, dependence, and development of chronic pain. Furthermore, opioid drugs are claimed to have cardiovascular depressant effects which increases the risk of hypotension if they were used routinely in patients with borderline hemodynamic profile. Therefore, there is an increased interest in opioid-sparing and opioid-free anesthesia and several international consensus statements were released to regulate and suggest protocols for opioid-sparing anesthetic regimens.
Lidocaine-based anesthesia had been recently reported as a successful regimen for induction of anesthesia in elderly population with better hemodynamic profile than opioid-based induction. The investigators hypothesize that lidocaine-based induction of anesthesia would provide superior hemodynamic profile compared to conventional opioid-based induction of anesthesia in emergency laparotomy.

Start Date15 Jan 2025

Sponsor / Collaborator

Cairo University

100 Clinical Results associated with Succinylcholine Chloride

100 Translational Medicine associated with Succinylcholine Chloride

100 Patents (Medical) associated with Succinylcholine Chloride

6,222

Literatures (Medical) associated with Succinylcholine Chloride

01 Nov 2025·JOURNAL OF PEDIATRICS

Atropine Versus Placebo for Neonatal Nonemergent Intubation: A Randomized Clinical Trial

Article

Author: Sandila, Navjot ; El-Naggar, Walid ; Baier, John ; Afifi, Jehier ; Hatfield, Tara ; Narvey, Micheal

OBJECTIVE:

To compare the rates of severe bradycardia (<80/min for >10 seconds) between neonates who received atropine-fentanyl-succinylcholine (atropine/standard-of-care group) vs placebo-fentanyl-succinylcholine (placebo/intervention group) before orotracheal intubation.

STUDY DESIGN:

A multicenter, double-blind, randomized clinical trial of neonates receiving nonemergent intubation. Randomization was by computer generated tables with random block size, stratified by postmenstrual age at randomization (<34 weeks and ≥34 weeks). The primary outcome was severe bradycardia during the whole procedure (from administration of the study medication until completion of last successful intubation). Secondary outcomes included any bradycardia (<100/min for >10 seconds), number and duration of intubation attempts and hypoxemia (<80% for >10 seconds). Safety outcomes included profound bradycardia (<60/min for >10 seconds), and receipt of chest compression or epinephrine. Analysis was by intention to treat.

RESULTS:

Seventy-three intubation events (60 infants) were randomized to administration of atropine (n = 24) or placebo (n = 49). Multiple attempts occurred in 33% of the events. No safety events occurred in either group. Severe bradycardia during the whole procedure was significantly higher in the placebo group compared with the atropine group (RR, 6.3; 95% CI, 1.2-34.1). The placebo group had significantly higher rates and duration of overall bradycardia, but lower rates and duration of hypoxemia compared with the atropine group, probably related to the lower proportion of multiple attempts (27% vs 46%; P = .09) and longer time to successful intubation (394 seconds vs 283 seconds; P = .08).

CONCLUSIONS:

Among neonates receiving premedication for nonemergent intubation, atropine significantly decreased the rates and duration of severe and overall bradycardia compared with placebo.

TRIAL REGISTRATION:

ClinicalTrials.gov: NCT01595399 (https://clinicaltrials.gov/study/NCT01595399).

12 Oct 2025·Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases

[Residual neuromuscular blockade during recovery from anesthesia in respiratory endoscopy: a report of three cases and literature review].

Review

Author: Xue, B ; Zhang, J ; Zhao, H ; Li, Y P ; Ren, H Q ; Wu, W J ; Chen, X ; Zhou, R R ; He, Y X

Objective: To investigate the clinical risks and preventive strategies of residual neuromuscular blockade during the recovery period after general anesthesia for respiratory endoscopy. Methods: A retrospective analysis of 3 cases of respiratory endoscopy under intravenous general anesthesia was conducted at Chuiyangliu Hospital Affiliated to Tsinghua University in 2024. Relevant literature was searched in the Pubmed and Wanfang database to summarize and analyze the clinical manifestations and risks. Results: The 3 patients at our hospital underwent thorough evaluation before operation. Sedation and analgesia were administered, along with 0.1-0.2 mg/kg dose of the neuromuscular blocking agent succinylcholine. The bronchoscopy procedure was successful. Neostigmine was administered for antagonism after bronchoscopy in all 3 cases, but adverse events occurred during anesthesia recovery. The first patient experienced persistent chest tightness, despite normal results from auxiliary examination, and psychological testing suggested an anxiety state, which improved after psychological intervention. The second patient developed respiratory and heart failure but was successfully resuscitated. The third patient experienced prolonged hypoxemia during the recovery period from anesthesia. Literature analysis showed that residual neuromuscular block during the recovery period can manifest clinically as chest tightness, respiratory muscle weakness, hypoxemia, respiratory failure and heart failure. Residual neuromuscular block is common and causes severe adverse clinical effects. However, despite its serious clinical impact, residual neuromuscular block has not attracted much clinical attention. Conclusion: The clinical hazards associated with residual neuromuscular blockade are not widely recognized, and effective preventive strategies must be developed to mitigate these risks.

01 Sep 2025·Air medical journal

Analgesia and Sedation Related to the Use of Long-Acting Neuromuscular Blockers: A Narrative Review

Review

Author: Frakes, Michael ; Cohen, Jason ; Ender, Vahé ; Wilcox, Susan R

Rapid sequence intubation is a standard procedure in critical care transport (CCT). Owing to its numerous benefits and clinical uses, rocuronium has become the first-line neuromuscular blocking agent in rapid sequence intubation, supplanting succinylcholine in many transport services. The deferred resumption of muscle activity with rocuronium may delay administering analgesia or sedation after intubation, resulting in awareness while paralyzed. We undertook a narrative review to evaluate this hazard in the existing literature. Numerous studies have revealed that 10% to 50% of intubated emergency department (ED) patients receive no sedation. Several retrospective reviews of intubated ED and transport patients found that the mean time to sedation or analgesia was longer for those receiving rocuronium than succinylcholine. Patients intubated with rocuronium in transport are more likely to receive neither analgesia nor sedation. Another study of a CCT program assesses data from 264 intubations, using a before and after model to analyze time to sedation after a formulary change from succinylcholine to rocuronium. Guidelines and prompts have not been successful at improving analgosedation systems. EDs have used pharmacists with success to improve post-intubation analgesia and sedation practices, but this is not feasible for transport. Although rocuronium has numerous benefits over succinylcholine for CCT systems, the existing literature demonstrates an ongoing risk of delays in sedation after intubation with rocuronium, with some patients not receiving any analgesia or sedation at all. Guidelines and prompts have not been successful, and ED solutions are impractical for the transport environment. Transport systems must remain vigilant for proper sedation after rocuronium administration.

News (Medical) associated with Succinylcholine Chloride

13 Oct 2025

·pharma.economictimes.indiatimes.com

DRL, Zydus recall drugs in US over manufacturing issues: USFDA

New Delhi: Drug majors Dr Reddy's Laboratories and Zydus Lifesciences are recalling products in the US for manufacturing issues , according to the US health regulator. In its latest Enforcement Report, US Food and Drug Administration ( USFDA ) stated that an American subsidiary of the Hyderabad-based drug major is recalling 571 vials of an injection used to relax muscles. Princeton-based Dr Reddy's is recalling the affected lot of Succinylcholine Chloride Injection due to "out-of-specification result during the six-month stability testing," the USFDA stated. The company initiated the nationwide (US) Class II recall on September 26 this year. The USFDA stated that US-based arm of Zydus Lifesciences is recalling over 1,500 boxes of an antiviral medication used primarily to treat chronic hepatitis B virus. Pennington, New Jersey-based Zydus Pharmaceuticals (USA) is recalling 912 and 600 bottles of Entecavir tablets in strengths of 0.5 mg and 1 mg, respectively due to "failed impurity/degradation specifications," it added. The drug firm initiated the Class II nationwide recall on September 24. As per the USFDA, a Class-II recall is initiated when the use of, or exposure to, a violative product may lead to temporary or medically reversible health consequences, or when the likelihood of serious adverse health outcomes is minimal. By Press Trust of India ,

06 Oct 2025

·www.businesswire.com

Alpha Cognition to Present Clinical Data at ASCP Annual Meeting

VANCOUVER, British Columbia & DALLAS--(BUSINESS WIRE)--Alpha Cognition Inc. (Nasdaq: ACOG), a commercial-stage biopharmaceutical company developing therapies for neurodegenerative diseases, today announced it will present new clinical insights on cholinesterase inhibitors and ZUNVEYL® (Benzgalantamine) at the American Society of Consultant Pharmacists (ASCP) Annual Meeting, October 23–25, 2025. On October 24, the Company will present: Poster 12: Acetylcholinesterase Inhibitors and Psychotropic Medication Use in ADRD Poster 3: Persistence of Therapy in ADRD Poster 4: Evidence-Based Approaches to Switching AChEIs in Alzheimer’s Disease “It has been more than three decades since cholinesterase inhibitors were introduced and a decade since the last went generic. Much of the product-specific knowledge has been lost,” said Dr. Denis Kay, Chief Scientific Officer of Alpha Cognition. “With ZUNVEYL, it is important to re-examine these treatments and provide renewed, evidence-based guidance for clinicians, patients, and families.” ASCP is the national professional society advancing safe, effective, person-centered medication use for older adults across long-term, post-acute, and senior care settings. About Alpha Cognition Inc. Alpha Cognition Inc. is a commercial stage, biopharmaceutical company dedicated to developing treatments for patients suffering from neurodegenerative diseases, such as Alzheimer’s disease and cognitive Impairment with mild Traumatic Brain Injury (“mTBI”), for which there are currently no approved treatment options. ALPHA-1062 formulated as a delayed release oral tablet (ZUNVEYL), is an FDA approved new generation acetylcholinesterase inhibitor for the treatment of Alzheimer’s disease, with expected minimal gastrointestinal side effects. ZUNVEYL’s active metabolite is differentiated from donepezil and rivastigmine in that it binds neuronal nicotinic receptors, most notably the alpha-7 subtype, which is known to have a positive effect on cognition. ALPHA-1062 is also being developed in combination with memantine to treat moderate to severe Alzheimer’s dementia, and as a sublingual formulation for cognitive Impairment with mTBI. INDICATION AND USAGE ZUNVEYL is a cholinesterase inhibitor indicated for the treatment of mild to moderate dementia of the Alzheimer’s type in adults. IMPORTANT SAFETY INFORMATION CONTRAINDICATIONS ZUNVEYL is contraindicated in patients with known hypersensitivity to benzgalantamine, galantamine, or to any inactive ingredients in ZUNVEYL. Serious skin reactions have occurred. WARNINGS AND PRECAUTIONS Serious Skin Reactions: Serious skin reactions (Stevens-Johnson syndrome and acute generalized exanthematous pustulosis) have been reported in patients receiving galantamine (the active metabolite of ZUNVEYL tablets). If signs or symptoms suggest a serious skin reaction, use of this drug should not be resumed, and alternative therapy should be considered. Anesthesia: See Drug Interactions Section Cardiovascular Conditions: Cholinesterase inhibitors, including ZUNVEYL, have vagotonic effects on the sinoatrial and atrioventricular nodes, leading to bradycardia and AV block. Bradycardia and all types of heart block have been reported in patients taking cholinesterase inhibitors, both with and without known underlying cardiac conduction abnormalities. Therefore, all patients should be considered at risk for adverse effects on cardiac conduction. Patients treated with galantamine up to 24 mg/day using the recommended dosing schedule showed a dose-related increase in risk of syncope. Gastrointestinal Conditions: Cholinesterase inhibitors, including ZUNVEYL, may increase gastric acid secretion. Patients should be monitored closely for active or occult gastrointestinal bleeding, especially those with a history of ulcer disease or those receiving concurrent nonsteroidal anti-inflammatory drugs (NSAIDs). Clinical studies of galantamine have shown no increase, relative to placebo, in the incidence of either peptic ulcer disease or gastrointestinal bleeding. Galantamine has been shown to produce nausea, vomiting, diarrhea, anorexia, and weight loss. Monitor the patient's weight during therapy with ZUNVEYL. Genitourinary Conditions: Although this was not observed in clinical trials with galantamine, cholinesterase inhibitors, including ZUNVEYL, may cause bladder outflow obstruction. Neurological Conditions: Cholinesterase inhibitors are believed to have some potential to cause generalized convulsions. Seizure activity may also be a manifestation of Alzheimer's disease. Patients with Alzheimer's disease should be monitored closely for seizures while taking ZUNVEYL. Pulmonary Conditions: Cholinesterase inhibitors, including ZUNVEYL, should be prescribed with care to patients with a history of severe asthma or obstructive pulmonary disease. Monitor for respiratory adverse reactions. ADVERSE REACTIONS The most common adverse reactions with galantamine tablets (≥5%) were nausea, vomiting, diarrhea, dizziness, headache, and decreased appetite. DRUG INTERACTIONS Use with Anticholinergics: Galantamine has the potential to interfere with the activity of anticholinergic medications. Use with Cholinomimetics and Other Cholinesterase Inhibitors: A synergistic effect is expected when cholinesterase inhibitors are given concurrently with succinylcholine, other cholinesterase inhibitors, similar neuromuscular blocking agents or cholinergic agonists such as bethanechol. USE IN SPECIFIC POPULATIONS Pregnancy: Based on animal data may cause fetal harm. Hepatic Impairment: In patients with moderate hepatic impairment, a decrease in clearance of galantamine was observed; therefore, a dosage adjustment is recommended. Use of ZUNVEYL in patients with severe hepatic impairment is not recommended. Renal Impairment: In patients with a creatinine clearance of 9 to 59 mL/min, an increase in exposure of galantamine was observed; therefore, a dosage adjustment is recommended. Use of ZUNVEYL in patients with creatinine clearance less than 9 mL/min is not recommended. These are not all of the possible side effects of ZUNVEYL. You can report side effects to the FDA. Visit www.fda.gov/MedWatch or call 1‑800‑FDA‑1088. Please click here for Full Prescribing Information. Forward-looking Statements This news release includes forward-looking statements within the meaning of applicable securities laws. Except for statements of historical fact, any information contained in this news release may be a forward‐looking statement that reflects the Company’s current views about future events and are subject to known and unknown risks, uncertainties, assumptions and other factors that may cause the actual results, levels of activity, performance or achievements to be materially different from the information expressed or implied by these forward-looking statements. In some cases, you can identify forward‐looking statements by the words “may,” “might,” “will,” “could,” “would,” “should,” “expect,” “intend,” “plan,” “objective,” “anticipate,” “believe,” “estimate,” “predict,” “project,” “potential,” “target,” “seek,” “contemplate,” “continue” and “ongoing,” or the negative of these terms, or other comparable terminology intended to identify statements about the future. Forward‐looking statements may include statements regarding the, the long-term benefits of ZUNVEYL, the Company’s timing and planned activities and business strategy to launch ZUNVEYL, the potential timing for the availability of ZUNVEYL, the potential future developments of ZUNVEYL, the market size and demand for ZUNVEYL and the Company’s potential growth opportunities, capital requirements,. Although the Company believes to have a reasonable basis for each forward-looking statement, we caution you that these statements are based on a combination of facts and factors currently known by us and our expectations of the future, about which we cannot be certain. The Company cannot assure that the actual results will be consistent with these forward-looking statements. These forward-looking statements are subject to certain risks, including risks regarding our ability to raise sufficient capital to implement our plans to commercialize ZUNVEYL, risks related to our focus on the long-term care market, risks regarding the efficacy and tolerability of ZUNVEYL, risks related to ongoing regulatory oversight on the safety of ZUNVEYL, risk related to market adoption of ZUNVEYL, risks related to the Company’s intellectual property in relation to ZUNVEYL, risks related to the commercial manufacturing, distribution, marketing and sale of ZUNVEYL, risks related to product liability and other risks as described in the Company’s filings with Canadian securities regulatory authorities and available at www.sedar.com and the Company’s filings with the United States Securities and Exchange Commission (the “SEC”), including those risk factors under the heading “Risk Factors” in the Company’s Form S-1/A registration statement as filed with the SEC on January 10, 2025 and available at www.sec.gov. These forward‐looking statements speak only as of the date of this news release and the Company undertakes no obligation to revise or update any forward‐looking statements for any reason, even if new information becomes available in the future, except as required by law.

Drug ApprovalClinical Result

17 Sep 2025

·pharma.economictimes.indiatimes.com

Zydus recalls antipsychotic and anesthesia drugs in US

New Delhi: Zydus Lifesciences US-arm Zydus Pharmaceuticals is undertaking a voluntary recall of antipsychotic drug ' Chlorpromazine Hydrochloride ' and anesthesia drug ' Succinylcholine Chloride ' in the country. According to the US FDA latest enforcement report, the Ahmedabad-based drugmaker is recalling ‘2,70,125’ vials of Succinylcholine Chloride Injection manufactured at the company’s Vadodara, Gujarat-based facility in India. Additionally, the drugmaker has also ordered 10 separate recalls for an undisclosed quantity of Chlorpromazine Hydrochloride Tablets, manufactured at the company’s Baddi, Himachal Pradesh-based facility in India. The total 10 voluntary actions includes Chlorpromazine Hydrochloride—10 mg, 20 mg, 50 mg, 100 mg, and 200 mg tablets and five of these recalls are of batches manufactured for Northstar Rx LLC. For Succinylcholine Chloride the recall was initiated on August 27 on account of an “Out-of-Specification test results obtained for any individual unknown degradation impurity.” Meanwhile, in the case of Chlorpromazine the company reported “presence of N-Nitroso Desmethyl Chlorpromazine above the recommended acceptable intake limit.” Notably, all eleven recalls—10 Chlorpromazine and one for Succinylcholine —are classed as Class II, meaning that the products may cause temporary or medically reversible adverse health consequences and the probability of serious adverse health consequences is remote. Chlorpromazine Hydrochloride blocks dopamine receptors in the brain, which helps reduce the effects of dopamine and is indicated for the treatment of certain mental disorders such as schizophrenia, psychotic disorders and is also used to relieve anxiety before surgery. Succinylcholine Chloride is a popular neuromuscular blocker , used as a part of general anesthesia procedure in the US. By Online Bureau ,

Clinical Study

100 Deals associated with Succinylcholine Chloride

External Link

KEGG	Wiki	ATC	Drug Bank
D00766	Succinylcholine Chloride	M03AB01	DBSALT000206

R&D Status

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Indication	Country/Location	Organization	Date
Muscle Hypotonia	China	Xian Hanfeng Pharmaceutical Co. Ltd.	01 Jan 1991
Anesthesia	United States	Sandoz, Inc.	20 Aug 1952

Clinical Result

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT04581395 (CTgov)	Phase 3	Butyrylcholinesterase Deficiency \| Myalgia \| Fasciculation	300	Rocuronium (Not Pretreated With Rocuronium)	tldywnlton = lpwuwacdkt ehyqintkik (ikwedmfmwy, cwqwhujuqa - zqxaztdhxb) View more	-	16 May 2024
				Succinylcholine+Rocuronium (Pre-treated With Rocuronium 1 Minute Before Succinylcholine Administration)	tldywnlton = eapiddqtgl ehyqintkik (ikwedmfmwy, ysijbqqjtv - bsdqtmydzx) View more
National Emergency Airway Registry Study (Pubmed \| Ann Emerg Med)	Not Applicable	-	-	Succinylcholine	lyzytfudiw(jlmnqbigum) = fzjzubqgxu xhvsaawdhj (pogvrlmkif ) View more	-	01 Dec 2018
				Rocuronium	lyzytfudiw(jlmnqbigum) = hdlzzslrwl xhvsaawdhj (pogvrlmkif ) View more
NCT02635542 (CTgov)	Phase 4	Postoperative Complications \| Complication	100	Cisatracurium (Group CIS)	ztpyaepnfq = urjlsfddkg dpswmxupcj (igsnvdygca, nxbtrmahjn - cinymxhzzy) View more	-	17 Jul 2018
				Succinylcholine (Group SUX)	ztpyaepnfq = yqwkwbnfxl dpswmxupcj (igsnvdygca, fjuhpjibmy - hpojhpqqgz) View more
NCT02425449 (CTgov)	Phase 4	-	19	succinylcholine (Arm 1)	ccuwdfdiod(zvdlxnjfdp) = osfaqwooef xjsmgdnesv (vtnxqpnksf, wiahfddkwm - zucsbktdjl) View more	-	02 Jan 2018
				succinycholine+succinylcholine (Arm 2)	kbegunbwft(qdvtfgxpfz) = ujtmorxoef fkvtplujfq (icstfkwtgp, 0.02) View more
NCT00751179 (P05700 \| 19.4.319, Pubmed \| Can Anaesth Soc J)	Phase 3	-	161	Rocuronium 0.6 mg/kg + Sugammadex 4.0 mg/kg	bervdhggqw(alctprcsme) = avjxkiauym zszcyqyxyj (uhjhtqipbk )	-	01 May 2014
				Succinylcholine 1.0 mg/kg	bervdhggqw(alctprcsme) = pxxbuuowxq zszcyqyxyj (uhjhtqipbk )
NCT00355368 (CTgov)	Phase 4	-	420	Succinylcholine (Succinylcholine)	mwjrtxfxkh = vfzqhnpfyl ngpartyilh (yamscbyorp, onlliwgcci - adhssojnhw) View more	-	15 Dec 2011
				Rocuronium (Rocuronium)	mwjrtxfxkh = zlqnkovuna ngpartyilh (yamscbyorp, mynfbyjccf - ecsiszmhaz) View more
NCT00355368 (Pubmed \| Crit Care)	Phase 4	-	401	Succinylcholine 1 mg/kg	sxvhybsoeo(mlyerynpup) = jylutmxbuq qzlnfvcnnn (obglxyhpeh )	-	16 Aug 2011
				Rocuronium 0.6 mg/kg	sxvhybsoeo(mlyerynpup) = xarrrgpzxu qzlnfvcnnn (obglxyhpeh )
NCT00462644 (CTgov)	Not Applicable	Adrenal Insufficiency \| Wounds and Injuries	30	etomidate+succinylcholine (Etomidate)	tcahvxixiz(fsogaggbhq) = wsvpxmfngk llwhlvydva (igzwqguydx, 8.4) View more	-	11 Nov 2009
				fentanyl+midazolam+succinylcholine (Fentanyl-Midazolam)	tcahvxixiz(fsogaggbhq) = yoxotvluab llwhlvydva (igzwqguydx, 13.4) View more

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