Succinylcholine (Anectine)

Class: Depolarizing neuromuscular blocker

Mechanism of Action: Depolarizing skeletal muscle relaxant used to facilitate endotracheal intubation.  It is very short-acting.  It combines with cholinergic receptors in the motor nerves to cause depolarization.  Neuromuscular transmission is thus inhibited.  It relaxes the muscles in the eyelids and jaw first, then progresses to the limbs, abdomen, and final the diaphragm and intercostals.  IT HAS NO EFFECT ON CONSCIOUSNESS.

Indications:  To facilitate endotracheal intubation, terminating laryngospasms, muscle relaxation, and/or temporary paralysis when muscle tone or seizure activity prevents any or all of the above.

Contraindications:  Known hypersensitivity, penetrating eye injury, inability to control airway, malignant hyperthermia, history of acute narrow-angle glaucoma, plasma pseudo cholinesterase, and/or the inability to support ventilations with oxygen and positive pressure ventilations.

Precautions/Special Considerations:  Pregnancy, may exacerbate hyperkalemia in trauma patients (hours post-trauma), cardiac disease, fractures, cardiac arrest, ventricular dysrhythmias, severe burns, children under 2, electrolyte imbalances, dehydration, neuromuscular disease, respiratory disease, collagen diseases, glaucoma, eye surgery, and elderly.

Interactions:  Certain drugs enhance the neuroumuscular-blocking action of Succinylcholine: lidocaine, procainamide, B-blockers, oxytocin, magnesium sulfate, and other neuro-muscular blockers.  Diazepam may reduce duration of action.

Side Effects:  Wheezing, respiratory depression, excessive salivation, apnea, aspiration, dysrhythmias, bradycardia, sinus arrest, hypertension, hypotension, increased intraocular pressure, increased intracranial pressure, malignant hyperthermia (very rare, but possible).

Dosage and Route:  Intravenously 1 to 1.5 mg/kg.  Another option is Intramuscularly at 3 to 4 mg/kg.  IV is the preferred method of administration.

Pharmacokinetics:  Onset: 30-60 seconds (IV) or 2-3 minutes (IM), Peak Effects:  1-3 minutes, Duration:  2-3 minutes (IV) or 10-30 minutes (IM), Half-Life: 5-10 minutes.

How It's Supplied:  Injectible liquid in multidose vial or powder form vials for reconstitution.  Vials normally found in 20, 50, or 100 mg/mL in liquid form or, 100 mg/vial, 500 mg/vial, or 1 g/vial powder form.