To the Editor:—  Regarding the optimal intubating dose of succinylcholine, 1,2I vividly recall the late Francis Foldes, M.D., then Chairman of the Department of Anesthesiology at Montefiore Medical Center, Bronx, New York, exhorting his residents to not dare use any more than 0.6 mg/kg for tracheal intubation. Furthermore, he taught us to administer the drug over 30–60 s, thus virtually eliminating fasciculations and myalgia, a benefit that neither Naguib et al.  or Kopman et al.  mentioned.

In their seminal reports 50 yr ago, Foldes 3and Hampton 4point out that the main advantage of succinylcholine is that it provides brief intense relaxation for intubation thus permitting the anesthesiologist to use smaller amounts of nondepolarizing muscle relaxants as dictated by the nature of the case. In the past decade, with the proliferation of newer short-acting nondepolarizing muscle relaxants and inexpensive train-of-four stimulators, this advantage seems to have been deemed insignificant or entirely forgotten. For example, to avoid large doses of nondepolarizing muscle relaxants, Caldwell 5suggested intubating with high doses of propofol or opioids and never mentioned succinylcholine even to condemn its use.

It is nice to see low-dose succinylcholine revisited.

Kopman AF, Zhaku B, Lai KS: The ‘intubating dose‘ of succinylcholine: The effect of decreasing doses on recovery time. Anesthesiology 2003; 99:1050–4
Naguib M, Samarkandi A, Riad W, Alharby SW: Optimal dose of succinylcholine revisited. Anesthesiology 2003; 99:1045–9
Foldes F: The use of succinylcholine for endotracheal intubation. Anesthesiology 1953; 14:93–5
Hampton LJ, Little DM Jr, Fuller EM: The use of succinylcholine to facilitate endotracheal intubation. Anesthesiology 1953; 14:382–9
Caldwell J: What’s new in muscle relaxants. ASA Newsletter 2003; 67:9