Succinylcholine-suxamethonium-Sux-Anectine®-Quelicin®-rothschillermd-1024x640.jpg

Succinylcholine (anectine)

CLASS : Neuromuscular Blocker (Depolarizing)

ACTIONS:

  • Binds with cholinergic receptors on the Nicotinic muscle motor-end plate which causes depolarization (often lead to fasciculations and some muscular contractions) and antagonizes action of acetylcholine to cause skeletal muscle and diaphragmatic paralyzation.

  • Subsequent neuromuscular transmission is inhibited as long as an adequate concentration of succinylcholine remains at receptor sites. It is then rapidly hydrolyzed by plasma cholinesterase.

INDICATIONS:

  • PATI (RSI) protocol

CONTRAINDICATIONS:

  • Hx of Malignant hyperthermia

  • Skeletal muscle myopathies

  • Airway anatomy makes intubation unlikely

  • Hypersensitivity

  • Acute rhabdomyolysis

  • Hyperkalemia

  • (Suspect condition in dialysis patients)

  • Trauma or burns >48 hours after injury

STANDARD PREP:

• 200 mg/10 ml

DOSAGES/ROUTES:

  • Usual dose is 1.5 mg/kg rapid IV, repeat once if needed

  • IM route (PATI Protocol doubles the dose for IM route)

Onset: < 1 min (IV); 2 – 3 min (IM) Duration: 5 – 10 min

PEDIATRIC DOSE:

  • Usual dose is 1–2mg/kgIV

SIDE EFFECTS:

• Initial muscle fasciculation
• Malignant hyperthermia
• May exacerbate hyperkalemia in post-trauma

crush injury, burn patients, patient with

paralyzed limb
• Excessive salivation

• Hypotension
• Bradycardia / Cardiac Arrest

PRECAUTIONS:

  • Succinylcholine has no effect on consciousness or pain

  • Duration of action is ~ 4 - 6 minutes and spontaneous respirations will usually resume in 5 - 10 minutes

  • Have alternative airway adjuncts available if unable to intubate

  • Monitor EKG, pulse oximetry, vital signs, neurological response

  • Patients suffering from electrolyte abnormalities and/or massive digitalis toxicity may suffer serious cardiac arrhythmias or cardiac arrest 2nd to hyperkalemia.