• Used during surgical procedures to produce skeletal muscle paralysis after induction of anesthesia and provision of opioid analgesics.

Contraindicated in:

• Hypersensitivity to succinylcholine or parabens
• Plasma pseudocholinesterase deficiency
• Pedi: Children and neonates (continuous infusions)
• Personal history of malignant hyperthermia.

Use Cautiously in:

• History of anaphylaxis to other neuromuscular blockers
• Familial history of malignant hyperthermia
• History of pulmonary disease, renal or liver impairment
• Major trauma, burns, or underlying myopathy (↑ risk of rhabdomyolysis and hyperkalemia, especially in children or adolescents)
• Glaucoma
• Electrolyte disturbances
• Receiving digoxin
• Fractures or muscular spasm
• Myasthenia gravis or myasthenic syndromes
• Geri: Geriatric or debilitated patients
• OB: Has been used in pregnant women undergoing cesarean section
• Pedi: Children and neonates (↑ risk of malignant hyperthermia).

Most adverse reactions to succinylcholine are extensions of pharmacologic effects

Resp: APNEA, bronchospasm.

CV: arrhythmias, bradycardia, hypotension.

F and E: HYPERKALEMIA.

MS: RHABDOMYOLYSIS, muscle fasciculation.
Misc: ANAPHYLAXIS, MALIGNANT HYPERTHERMIA, myoglobinemia (↑ in children), myoglobinuria (↑ in children), tachyphylaxis.

Drug-Drug:

• Intensity and/or duration of paralysis may be prolonged by pretreatment with general anesthesia, aminoglycosides, polymyxin B, colistin, clindamycin, lidocaine, quinidine, procainamide, beta blockers, lithium, cyclophosphamide, phenelzine, potassium-losing diuretics, and magnesium salts.
• ↑risk of adverse cardiovascular reactions with opioid analgesics or digoxin.

• Injection: 20 mg/mL; 100 mg/mL;

Test Dose

• IV (Adults): 5–10 mg (0.1 mg/kg), then assess respiratory function.

Short Procedures

• IV (Adults): 0.6 mg/kg (range 0.3–1.1 mg/kg) up to 150 mg total dose; additional doses depend on response, maintenance: 0.04–0.07 mg/kg q 5–10 min as needed.
• IV (Children): 1–2 mg/kg, up to 150 mg; additional doses depend on response, maintenance: 0.3–0.6 mg/kg q 5–10 min as needed, (continuous infusion not recommended in children or neonates because of the risk of malignant hyperthermia).

Prolonged Procedures

• IV (Adults): 2.5 mg/min infusion (range 0.5–10 mg/min).

Intramuscular Dosing

• IM (Adults and Children): Up to 3 — 4 mg/kg (total dose not to exceed 150 mg).

Anectine, Quelicin

• Prevents neuromuscular transmission by blocking the effect of acetylcholine at the myoneural junction.
• Has agonist activity initially, producing fasciculation.
• Causes the release of histamine.
• Has no analgesic or anxiolytic effects.

• Skeletal muscle paralysis.

Therapeutic Classification: neuromuscular blocking agents-depolarizing

Absorption: Well absorbed after deep IM administration.

Distribution: Widely distributed into extracellular fluid. Crosses the placenta in small amounts.

Metabolism/Excretion: 90% metabolized by pseudocholinesterase in plasma. 10% excreted unchanged by the kidneys.

Half-life: Unknown.

(skeletal muscle paralysis)

• Explain all procedures to patient receiving succinylcholine therapy without anesthesia, because consciousness is not affected by succinylcholine alone. Provide emotional support.
• Reassure patient that communication abilities will return as the medication wears off.

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