Succinylcholine

See critical care quick reference for drug doses by weight.

General

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.
  1. ↑ Gronert GA. "Succinylcholine Hyperkalemia after Burns." Anesthesiology 7 1999, Vol.91, 320.
  2. ↑ Eisenkraft JB et al. Resistance to succinylcholine in myasthenia gravis: a dose-response study. Anesthesiology. 1988 Nov;69(5):760-3
  3. ↑ Levitan R. Safety of succinylcholine in myasthenia gravis. Ann Emerg Med. 2005 Feb;45(2):225-6.
  4. ↑ Dillon FX. Anesthesia issues in the perioperative management of myasthenia gravis. Semin Neurol. 2004 Mar;24(1):83-94. Review.
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