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Succinylcholine
Aka: Succinylcholine, Suxamethonium Chloride, Anectine
- See Also
- Paralytic Agent
- Precautions
- Used only in Anesthesia, emergency and Intensive Care
- Airway and respiratory control is critical after use
- Paralytic Agents do not alter Level of Consciousness
- Must be used with sedation and analgesia
- Indication
- Paralysis in Rapid Sequence Intubation
- Contraindications (use Rocuronium as alternative)
- Hyperkalemia risk
- Malignant Hyperthermia
- Burn Injury (more than 5 days from injury until healed)
- Muscle crush injury (more than 5 days from injury until healed)
- Spinal cord injury or stroke (more than 5 days from onset until 6 months later)
- Neuromuscular disorder (e.g. MS, Muscular Dystrophy, Myopathy)
- Serious intra-abdominal infection (more than 5 days from onset until infection resolved)
- Myopathy with elevated Creatine Phosphokinase
- Malignant Hyperthermia history or Family History
- Penetrating Eye Injury
- Narrow Angle Glaucoma
- Increased Intracranial Pressure
- Congestive Heart Failure
- Mechanism
- Depolarizing Neuromuscular Blocking Agent (prototype)
- Preparations
- Succinylcholine 20 mg/ml in 200 mg/10 ml vial
- Dose (based on Ideal Body Weight in obese patients)
- Initial dose
- IV Dose: 1 to 1.5 mg/kg up to 150 mg IV
- Example: 120 mg for an 80 kg patient
- IM Dose: 2-4 mg/kg up to 150 mg IM
- Raise dose if used with non-depolarizing agent
- Wait at least one minute for defasciculation prior to intubating (risk of Emesis)
- Avoid under-dosing (risk of difficult intubation)
- Maintenance dosing (if needed)
- Starts 5-10 minutes after initial dose
- Please see other references for maintenance dosing
- May be used as a continuous infusion
- Pharmacokinetics
- Onset: <1 minute
- Duration: 4-6 minute (up to 8 minutes)
- Adverse Effects
- Bradycardia
- Hyperkalemia
- Masseter muscle spasm
- Malignant Hyperthermia
- Increased Intracranial Pressure
- Oxygen Saturation drops more quickly with Succinylcholine due to oxygen utilization for paralysis (depolarization)
- References
- Miller in Katzung (1989) Pharmacology, p. 323-33
- Savarese in Miller (2000) Anesthesia, p. 412-90
- (2003) Lexicomp Drug database for Pocket PC