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Succinylcholine
From WikEM
See critical care quick reference for drug doses by weight.
Contents
General
- Type: Neuromuscular blocker
- Dosage Forms: IV or IM
- Common Trade Names: Anectine; Quelicin; Quelicin-1000
Adult Dosing
- 1.5mg/kg IV
- 4mg/kg IM (in extremis)
Pediatric Dosing
See critical care quick reference for drug doses by weight.
Special Populations
- Pregnancy Rating: C
- Lactation: Unknown if compound is excreted in breast milk
- Renal Dosing
- Adult: None specified by manufacturer
- Pediatric
- Hepatic Dosing
- Adult: None specified by manufacturer
- Pediatric
Contraindications
- Hyperkalemia
- Preexisting hyperkalemia
- Rhabdomyolysis
- Burns >5 days old[1]
- Crush injury >5 days old
- Severe infection > 5days old
- Neuromuscular diseases (e.g. Myasthenia Gravis), myopathies
- Multiple sclerosis
- ALS
- Denervating injuries >72hrs old (stroke, spinal cord injury, etc.)
- Immobilization, including found down with unknown time
- History of Malignant Hyperthermia
- Allergy to class/drug
- Tetanus, botulism, and other exotoxin infections
Conditions Requiring Decreased Dosing
Use in Myesthenia Gravis
Increased dosing required for patients with Myasthenia gravis due to the destruction of nicotinic receptors from auto-antibodies *
- Anestheia literature supports increased dose of 2.0mg/kg[2]
- There is no evidence to support claims of increased hyperkalemia[3]
- If the patient is on a cholinesterase inhibitor there will be prolonged effect of the paralytic.[4]
Adverse Reactions
Serious
- Fatal hyperkalemia
- Malignant hyperthermia
- Masseter spasm
Common
Pharmacology
- Onset: IV: 30-60 seconds; IM: 2-3 minutes
- Metabolism: Plasma pseudocholinesterase hydrolysis
- Excretion: Urine
- Mechanism of Action: Depolarization of the myoneural junction motor endplate
- Duration of Action: IV: 4-6 minutes; IM 10-30 minutes
See Also
References
- Levitan, R. Annals of EM. Vol 45, Issue 2. Safety of succinylcholine in myasthenia gravis.
- ↑ Gronert GA. "Succinylcholine Hyperkalemia after Burns." Anesthesiology 7 1999, Vol.91, 320.
- ↑ Eisenkraft JB et al. Resistance to succinylcholine in myasthenia gravis: a dose-response study. Anesthesiology. 1988 Nov;69(5):760-3
- ↑ Levitan R. Safety of succinylcholine in myasthenia gravis. Ann Emerg Med. 2005 Feb;45(2):225-6.
- ↑ Dillon FX. Anesthesia issues in the perioperative management of myasthenia gravis. Semin Neurol. 2004 Mar;24(1):83-94. Review.
