Administration of succinylcholine for electroconvulsive therapy after organophosphate poisoning: a case study.

A 53-year-old man was admitted to the hospital psychiatric unit for evaluation and treatment following a recent suicide attempt, which involved ingestion of an unknown amount of Dursban (DowElanco, Indianapolis, Ind) and a self-inflicted knife wound to the abdomen. Dursban is a commercially prepared organophosphate insecticide in which the active ingredient is chlorpyrifos in a petroleum distillate solvent. The patient received 7 electroconvulsive therapy treatments during a 2-week hospital stay. The anesthetic regimen included methohexital for induction and succinylcholine for neuromuscular relaxation. Cholinesterase levels were low on admission at 5,780 IU (reference range, 11,000-15,000), yet succinylcholine was used successfully at low doses.