Succinylcholine: Difference between revisions
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*History of [[Malignant Hyperthermia]] | *History of [[Malignant Hyperthermia]] | ||
*Allergy to class/drug | *Allergy to class/drug | ||
==Increased Dosing=== | |||
Increased dosing required for patients with [[Myaesthenia Gravis]] due to the destruction of nicotinic receptors from auto-antibodies * | |||
*Anestheia literature supports increased dose of 2.0mg/kg<ref>Eisenkraft JB et al. Resistance to succinylcholine in myasthenia gravis: a dose-response study. Anesthesiology. 1988 Nov;69(5):760-3</ref> | |||
*There is no evidence to support claims of increased hyperkalemia<ref>Levitan R. Safety of succinylcholine in myasthenia gravis. Ann Emerg Med. 2005 Feb;45(2):225-6.</ref> | |||
*If the patient is on a cholinesterase inhibitor there will be prolonged effect of the paralytic.<ref>Dillon FX. Anesthesia issues in the perioperative management of myasthenia gravis. Semin Neurol. 2004 Mar;24(1):83-94. Review.</ref> | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
Revision as of 12:06, 20 October 2015
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
- 1.5 mg/kg IV
- 4 mg/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
- Burns >5d old
- Crush injury >5d old
- Severe infection >5d old
- Neuromuscular diseases (e.g. Myasthenia Gravis), myopathies
- History of Malignant Hyperthermia
- Allergy to class/drug
Increased Dosing=
Increased dosing required for patients with Myaesthenia Gravis due to the destruction of nicotinic receptors from auto-antibodies *
- Anestheia literature supports increased dose of 2.0mg/kg[1]
- There is no evidence to support claims of increased hyperkalemia[2]
- If the patient is on a cholinesterase inhibitor there will be prolonged effect of the paralytic.[3]
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
Sources
- Levitan, R. Annals of EM. Vol 45, Issue 2. Safety of succinylcholine in myasthenia gravis.
- ↑ 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.