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What is Succinylcholine
Succinylcholine is a parenteral, short-acting, depolarizing neuromuscular blocking agent (NMBA) indicated as an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Succinylcholine has the fastest onset time of any NMBA, typically allowing intubation within 60 seconds. In addition to its rapid onset and short duration, advantages of succinylcholine include its organ-independent metabolism and ability to be administered intramuscularly in patients without venous access.
Succinylcholine induces histamine release and vagal stimulation. Bradycardia is more common in infants and children compared to adults; repeated dosing also increases the risk of bradycardia.
Succinylcholine-induced muscle contraction and fasciculation can cause sudden, large releases of potassium, which may induce cardiac dysrhythmias.
Brand Names
Anectine
Quelicin
Indications & Dosage
- electroconvulsive therapy (ECT)
- endotracheal intubation
- neuromuscular blockade during surgery
- rapid-sequence intubation
Side Effects
- acute quadriplegic myopathy syndrome
- anaphylactoid reactions
- angioedema
- anxiety
- apnea
- asystole
- bradycardia
- bronchospasm
- cardiac arrest
- conjunctivitis
- dyspnea
- erythema
- flushing
- hyperkalemia
- hypersalivation
- hypertension
- hypotension
- hypoxia
- increased intracranial pressure
- keratitis
- malignant hyperthermia
- muscle paralysis
- myalgia
- myoglobinuria
- myopathy
- ocular hypertension
- pruritus
- rash
- renal failure (unspecified)
- respiratory depression
- rhabdomyolysis
- sinus tachycardia
- skin erosion
- skin ulcer
- thrombosis
- tolerance
- urticaria
- weakness
- wheezing
- xerophthalmia
Monitoring Parameters
- arterial blood gases (ABGs)
- serum electrolytes
- serum magnesium
Contraindications
- accidental exposure
- acid/base imbalance
- adrenal insufficiency
- anemia
- asthma
- bone fractures
- breast-feeding
- burns
- cardiac disease
- children
- cholinesterase inhibitor toxicity
- chronic lung disease (CLD)
- chronic obstructive pulmonary disease (COPD)
- corticosteroid therapy
- dehydration
- digitalis toxicity
- electrolyte imbalance
- glaucoma
- Guillain-Barre syndrome
- hepatic disease
- hypercalcemia
- hyperkalemia
- hypermagnesemia
- hypocalcemia
- hypokalemia
- hypothermia
- infants
- infection
- labor
- malignant hyperthermia
- metabolic acidosis
- metabolic alkalosis
- myasthenia gravis
- myopathy
- myxedema
- neonates
- neuromuscular blocking agent hypersensitivity
- neuromuscular disease
- obesity
- obstetric delivery
- ocular trauma
- peptic ulcer disease
- pregnancy
- pseudocholinesterase deficiency
- pulmonary disease
- renal disease
- requires a specialized care setting
- requires an experienced clinician
- respiratory acidosis
- respiratory alkalosis
- rhabdomyolysis
- trauma
Interactions
- Acebutolol
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Codeine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Propoxyphene
- Acetazolamide
- Alfentanil
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Amide local anesthetics
- Aminoglycosides
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amphotericin B
- Amphotericin B cholesteryl sulfate complex (ABCD)
- Amphotericin B lipid complex (ABLC)
- Amphotericin B liposomal (LAmB)
- Apomorphine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atenolol
- Atenolol; Chlorthalidone
- Atracurium
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Bacitracin
- Belladonna; Opium
- Bendroflumethiazide; Nadolol
- Benzhydrocodone; Acetaminophen
- Benzodiazepines
- Benzonatate
- Beta-blockers
- Betaxolol
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Botulinum Toxins
- Brimonidine; Timolol
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Calcium
- Calcium Acetate
- Calcium Carbonate
- Calcium Carbonate; Magnesium Hydroxide
- Calcium Carbonate; Risedronate
- Calcium Carbonate; Simethicone
- Calcium Chloride
- Calcium Gluconate
- Calcium-channel blockers
- Calcium; Vitamin D
- Capreomycin
- Carbamazepine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbonic anhydrase inhibitors
- Carteolol
- Carvedilol
- Chloroquine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chromium
- Cisatracurium
- Clevidipine
- Clozapine
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Colistimethate, Colistin, Polymyxin E
- Corticosteroids
- Cyclophosphamide
- Cyclosporine
- Demeclocycline
- Desflurane
- Dexpanthenol
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Digoxin
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diltiazem
- Diphenhydramine; Hydrocodone; Phenylephrine
- Donepezil
- Donepezil; Memantine
- Dorzolamide; Timolol
- Doxycycline
- Enalapril; Felodipine
- Enflurane
- Esmolol
- Ester local anesthetics
- Felodipine
- Fentanyl
- Fosphenytoin
- Galantamine
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Hetastarch; Dextrose; Electrolytes
- Homatropine; Hydrocodone
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Ibuprofen; Oxycodone
- Indapamide
- Irinotecan
- Irinotecan Liposomal
- Isoflurane
- Isradipine
- Labetalol
- Levobetaxolol
- Levobunolol
- Levomethadyl
- Levorphanol
- Lincosamides
- Lithium
- Loop diuretics
- Magnesium
- Mepenzolate
- Meperidine
- Meperidine; Promethazine
- Methadone
- Methazolamide
- Methohexital
- Metoclopramide
- Metoprolol
- Minocycline
- Mivacurium
- Morphine
- Morphine; Naltrexone
- Nabilone
- Nadolol
- Nalbuphine
- Nebivolol
- Nebivolol; Valsartan
- Neostigmine
- Nicardipine
- Nifedipine
- Nimodipine
- Nisoldipine
- Omadacycline
- Oral Contraceptives
- Oxycodone
- Oxymorphone
- Oxytocin
- Pancuronium
- Penbutolol
- Perindopril; Amlodipine
- Phenelzine
- Phenylephrine; Promethazine
- Phenytoin
- Physostigmine
- Pindolol
- Polymyxin B
- Polymyxins
- Procainamide
- Promethazine
- Propoxyphene
- Propranolol
- Pyridostigmine
- Quinidine
- Quinine
- Remifentanil
- Rivastigmine
- Rocuronium
- Sarecycline
- Sedating H1-blockers
- Sevoflurane
- Skeletal Muscle Relaxants
- Sotalol
- Sufentanil
- Tapentadol
- Terbutaline
- Tetracycline
- Tetracyclines
- Thalidomide
- Theophylline, Aminophylline
- Thiazide diuretics
- Thiopental
- Timolol
- Trandolapril; Verapamil
- Vancomycin
- Vecuronium
- Verapamil
