Definition
Upregulation of Acetylcholine receptors leads to increased sensitivity to Succinylcholine and risk for hyperkalemia due to depolarization of the muscle membrane. May occur in:
1) Spinal Cord Injury
2) Stroke
3) Burns
• After immobilization, upregulation of NAChRs
• Avoid Succinylcholine – especially after 24 hours post burn and for up to 1-2 years post burn (may take months to years to return to preburn levels of NAChR)
• Resistance to nondepolarizing NMBDs and increased sensitivity to succinylcholine
4) Prolonged immobility
5) Prolonged exposure to neuromuscular blockers
• Typically seen in ICUs to facilitate mechanical ventilation, tetanus, status epilepticus, reduction in oxygen consumption
6) Multiple Sclerosis
• Demyelination of the CNS
• Attention autonomic dysfunction
7) Guillain Barre’ syndrome
• Demyelination and axonal degeneration produce functional denervation of muscle and upregulation of NAchRs at the postsynaptic membrane
• Pay attention to autonomic dysfunction
• Maintain adequate preload, temperature control, postural changes, blood loss
