Decamethonium iodide: a reappraisal.

DECAMETHONIUM iodide (CIO) was first described by Barlow and Ing, and by Paton and Zaimis, in 1948. The following year it was introduced into anaesthesia as a result of the work of Organe, and of Hewer, Lucas, Prescott and Rowbotham. Apart from the initial enthusiasm decamethonium has never found much favour with anaesthetists. In 1950 an editorial in the Lancet, comparing it with Gallamine, stated that the position of decamethonium was "less happy, mainly because no satisfactory antidote for it had yet been found". It went on to mention reports of delayed recovery and to conclude that "much more experience will be needed before its place in anaesthesia can be fully assessed". The position has changed little since. Two years later the same journal stated in an annotation that "of the depolarizing group decamethonium had a brief period of popularity", and again the reason given for its failure to replace other relaxants was lack of a suitable antidote. Then in 1954, describing the Cardiff anaesthetic record system, Mushin, Lewis-Faning and Morgan wrote, "decamethonium, though commonly used at the time our card was first designed, is now little used and has been deleted from the record in the latest edition"; and Lee (1953), in his Synopsis of Anaesthesia, remarks that he seldom feels the need of this relaxant. It is hardly surprising that Burroughs Wellcome & Co. are ceasing to market their preparation, Syncurine (personal communication).