Succinylcholine

• Succinylcholine

• Anectine

Classification:

• Depolarizing neuromuscular blocking agent

Mechanism of Action:

• Attaches to cholinergic (nicotinic) receptors of the motor end plate and produces depolarization (which may produce fasciculations).  Subsequent blockade of impulse transmission is produced as succinylcholine is not rapidly hydrolyzed by acetylcholinesterase.

Indications:

• Rapid sequence induction

Contraindications:

• Penetrating eye injuries
• Narrow angle glaucoma
• Personal or family history of malignant hyperthermia
• Pseudocholinesterase deficiency (prolonged paralysis)
• Burns greater than 24hours old
• Spinal cord injuries after the acute phase.  May precipitate cardiac arrest due to hyperkalemia.  Greatest risk time is 7-10 days post injury.  Onset of increased risk is not known
• Multiple trauma after the acute phase.  May precipitate cardiac arrest due to hyperkalemia.  Onset of increased risk is not known.  Greatest risk time is 7-10 days post injury
• Hyperkalemia
• Neuromuscular disease
• Crush injuries

Precautions:

• All advanced airway equipment, and those skilled in its use, must be ready, including cricothyrotomy supplies
• Patient should be sedated prior to administration, succinylcholine has no sedative or analgesic properties
• Monitor EKG
• Monitor BP
• Monitor pulse oximetry
• Use ETCO₂ detector on all ventilated patients
• Patient must be hyperoxygenated prior to administration, but not hyperventilated unless patient has inadequate respiratory effort and must be assisted
• Use cautiously in patients on digoxin or with digoxin toxicity
• Use cautiously in bronchogenic carcinoma
• Use cautiously in neuromuscular disease
• Use cautiously in patients with muscle spasm, especially when due to fractures, fasciculations can worsen injury
• Use cautiously with hepatic impairment due to risk of prolonged effect
• Use extreme caution in male patients less than 8 years old due to possibility of previously undiagnosed neuromuscular disorders causing Hyperkalemia
• Increased incidence of malignant hyperthermia

Adverse Effects:

• Bradycardia.  If not responsive to hyperventilation with 100% O2, use atropine
• Apnea
• Cardiac arrest
• Transient increase in K⁺
• Prolonged paralysis
• Cardiac arrest in children with undiagnosed myopathies, due to hyperkalemia
• If cardiac arrest occurs in children post succinylcholine that is not explained by airway/ventilation problems, suspect hyperkalemia and treat accordingly

Dose:

• 1 mEq/kg slow IV, IO; repeat 0.5 mEq/kg q 10 min PRN

• Same as adult dose

• IV, IO

• Compendium of Pharmaceuticals and Specialties (CPS)
• Pharmacology for the Prehospital Professional 2nd Edition