ABSTRACT : Suxamethonium - good olden drug - depolarizing muscle relaxant in the anaesthesiologist armamentarium is gradually loosing significance in the present day anaesthesia practice due to advent of newer drugs. But still, it can be life saving in some particular situations. It’s usage is presently limited for learning intubation skills for beginners and in difficult airway drills.

METHODS : I describe the usage of suxamethonium for intubation and maintenance in a case of peritonitis with difficult airway and co-morbid medical conditions for emergency laparatomy.

RESULTS : Usage of Suxamethonium in this particular case has helped in managing the case successfully. Suxamethonium was preferred as anaesthesia plan was for crash induction in difficult airway (Mallampatti grade III) with edentulous incisors. Maintenance was again with suxamethonium for the reason that surgery lasted for twenty minutes and non-depolarising agents were avoided, anticipating delayed recovery due to co-morbid condition of the patient.

CONCLUSIONS : Suxamethonium still plays a pivotal role in anaesthesia practice especially in cases for crash induction with difficult airway and ofcourse, rarely used in maintenance, if surgery ends up fast.