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higher in Northern Italy, Tuscany and Sardinia, much lower in Southern Italy, especially in Calabria (70%) and Campania (76%)

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Indications Succinylcholine is used as an adjunct to general anesthesia for: Rapid sequence intubation Skeletal muscle relaxation during surgery Mechanical ventilation Electroconvulsive therapy (ECT) Advantages: Rapid onset: 3060 seconds Short duration: ~610 minutes These properties make it ideal when: Immediate airway protection is needed (e.g., aspiration risk) A short-acting paralytic is preferred if intubation fails Contraindications: Genetic Pseudocholinesterase Deficiency Autosomal recessive condition ( see box ) Reduced enzyme production prolonged drug effect Prevalence: Heterozygotes: ~1 in 500 Homozygotes: 1 in 2,0005,000 Effects: Heterozygotes: ~30% prolonged blockade Homozygotes: 23 hours of paralysis Precaution: Patients with Genetic Pseudocholinesterase Deficiency Pseudocholinesterase deficiency is an autosomal recessive inherited condition in which the production of the enzyme 6) is impaired due to the presence of one of several identified single-nucleotide polymorphisms of the gene encoding the enzyme that is found on chromosome 3

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Brian Sandoval was proposing a 40-cent-per-pack cigarette tax increase, but anti-smoking advocates pushed for a higher rate