Name

succinylcholine (Anectine®)

Class

Neuromuscular Blocker (Depolarizing)

Description/Mechanism

Succinylcholine has the briefest duration of action of all neuromuscular blocking drugs, making it a drug of choice for such procedures as terminating laryngospasm, endotracheal intubation, and electroconvulsive shock therapy.

Like nondepolarizing blockers, depolarizing drugs also bind to the nicotinic M receptors for acetylcholine. However, because they cause an initial depolarization of the muscle membrane, they often lead to fasciculations and some muscular contractions prior to inducing paralysis.

Onset

< 1 min

Duration

5 minutes

Indications

To facilitate intubation

Terminating laryngospasm

Muscle relaxation

Contraindications

Penetrating eye injury (succinylcholine increases intraocular pressure)

Inability to control airway and/or support ventilations with oxygen and positive pressure

Adverse Reactions

Hypotension

Bradycardias

Dysrhythmias

Initial muscle fasiculations

Excessive salivation

Malignant hyperthermia (rare)

Allergic reactions

Succinylcholine may exacerbate hyperkalemia in trauma patients (hours post-trauma).

Drug Interactions

Oxytocin, beta blockers, organophosphates may potentiate effects

Diazepam may reduce duration of action.

Cardiac glycosides may induce dysrhythmias

Supplied

40 mg in 2 ml ampule (20 mg/ml)

100 mg in 5 ml ampule (20 mg/ml)

Multidose vial

Dose/Administration

Adult

IV: 1.5mg/kg rapid, repeat once if needed.

Pediatric

IV: 1 mg/kg rapid, repeat once if needed.

Special Consideration

If the patient is conscious, explain the effects of the medication prior to administration.

Pregnancy Safety: Category C

Premedication with atropine should be strongly considered, particularly in the pediatric age group. Premedicating with lidocaine may blunt any increase in intracranial pressure associated with intubation. Finally, diazepam or another sedative should be used in any conscious patient undergoing neuromuscular blockade.

Neuromuscular blocking agents will produce respiratory paralysis. Therefore, intubation and ventilatory support must be readily available.

Carefully monitor the patient and be prepared to resuscitate.

Administer with caution to patients with severe trauma, burns, and electrolyte imbalances (high potassium levels).

Brain or spinal cord injury may prolong effects.

Children are not as sensitive to succinylcholine on a weight basis as adults and may require higher doses.

Succinylcholine has no effect on consciousness or pain.

Will not stop neuronal seizure activity.