To the Editor: 

It is always helpful when a clinical study demonstrates that a commonly used medication lacks a potentially harmful side effect. Such was the case in the recent article by Turan et al. , in which it was demonstrated that succinylcholine produced an inconsequentially greater release of myoglobin in patients receiving statins than in patients not receiving statins.1Importantly, there was no difference in plasma potassium, plasma creatine kinase, or postoperative myalgias. Equally importantly, there was no comparison group in which patients receiving statins were randomly assigned to receive either no relaxant or a relaxant other than succinylcholine.

Curiously, the editorial by Lee that discussed the study by Turan et al.  was titled “Succinylcholine Should Be Avoided in Patients on Statin Therapy.”1,2Where did Lee find the evidence for this conclusion within the study by Turan et al. ? Where is the evidence that avoiding succinylcholine and using either no relaxant or an alternative relaxant would result in reduced release of myoglobin or better outcomes for patients? Where is the evidence that future patients will benefit if we follow Lee's advice to update the advantages and disadvantages of succinylcholine in light of the study by Turan et al. ? Should we interpret this study to say that statins should be withdrawn in patients who will require succinylcholine? I think the most prudent course is to interpret the data in the same way as the authors: “the effect of succinylcholine given to patients taking statins is likely to be small and probably of limited consequence.”

Turan A, Mendoza ML, Gupta S, You J, Gottlieb A, Chu W, Saager L, Sessler DI: Consequences of succinylcholine administration to patients using statins. ANESTHESIOLOGY 2011; 115:28–35
Lee C: Succinylcholine should be avoided in patients on statin therapy. ANESTHESIOLOGY 2011; 115:6–7