A 30-year-old patient presents with an open globe injury after a road traffic accident and requires emergency surgery. Why is succinylcholine relatively contraindicated in this patient?

• A It causes pupillary constriction leading to iris prolapse
• B It causes direct vasodilation of the choroidal circulation
• C It raises intracranial pressure which secondarily increases IOP
• D It increases intraocular pressure by contracting extraocular muscles ✓

Explanation

Succinylcholine increases intraocular pressure by causing tonic contraction of extraocular muscles and possibly via choroidal vascular dilation. In an open globe, this can cause extrusion of intraocular contents. Lidocaine pretreatment or a defasciculating dose of a non-depolarizing agent may attenuate this rise, but rocuronium is preferred for RSI in open eye injuries.

Reference: Morgan and Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.