Succinylcholine: Difference between revisions
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Latest revision as of 21:58, 20 March 2026
See critical care quick reference for drug doses by weight.
General
- Type: Neuromuscular blocker
- Dosage Forms: IV or IM
- Common Trade Names: Anectine; Quelicin; Quelicin-1000
Adult Dosing
- 1.0-1.5mg/kg IV
- Increase dose in cases of shock
- 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, crush injuries, spinal cord injuries, strokes, and intraabdominal sepsis >5 days old[1][2][3]
- Neuromuscular diseases, e.g., multiple sclerosis, amyotrophic lateral sclerosis, myasthenia gravis myopathies
- Myopathies
- spinal cord damage (1 week - 3 months old)
- History of Malignant Hyperthermia
- Immobilization, including found down with unknown time
- 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[4]
- There is no evidence to support claims of increased hyperkalemia[5]
- If the patient is on a cholinesterase inhibitor there will be prolonged effect of the paralytic.[6]
Adverse Reactions
Serious
- Fatal hyperkalemia
- Malignant hyperthermia
- Masseter spasm
Common
Pharmacology
- Structure of two acetylcholine molecules linked through acetate methyl groups
- 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
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.
| Indication | Dose | Context | Route | Population |
|---|---|---|---|---|
| Rapid sequence intubation | 1.5 mg/kg | Paralytic | IV | Adult |
| Rapid sequence intubation | 2.0 mg/kg | Paralytic | IV | Pediatric |
| Rapid sequence intubation | 4 mg/kg | Paralytic (IM) | IM | Adult |
See Also
Airway Pages
- Pre-intubation
- Induction
- Intubation
- Surgical airways
- Post-intubation
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.
- ↑ Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. St. Louis, MO: Elsevier; 2014: 855-871.
- ↑ Tintinalli JE, Stapczynski JS, Ma OJ, et al, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill; 2012: 1620-1621.
- ↑ 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.