No

Neuromuscular Blocker Agent, Depolarizing

Produces skeletal muscle relaxation in procedures of short duration such as endotracheal intubation or endoscopic exams

C

Malignant hyperthermia, myopathies associated with elevated serum creatine phosphokinase (CPK) values, narrow-angle glaucoma, hyperkalemia, penetrating eye injuries, disorders of plasma pseudocholinesterase, hypersensitivity to succinylcholine or any component

Use in pediatrics and adolescents; use with caution in patients with pre-existing hyperkalemia, paraplegia, extensive or severe burns, extensive denervation of skeletal muscle because of disease or injury to the CNS or with degenerative or dystrophic neuromuscular disease; may increase vagal tone

>10%:

Ocular: Increased intraocular pressure

Miscellaneous: Postoperative stiffness

1% to 10%:

Cardiovascular: Bradycardia, hypotension, cardiac arrhythmias, tachycardia

Gastrointestinal: Intragastric pressure, salivation

<1%: Hypertension, rash, itching, erythema, hyperkalemia, myalgia, myoglobinuria, apnea, bronchospasm, circulatory collapse, malignant hyperthermia

Causes of prolonged neuromuscular blockade:

Excessive drug administration

Cumulative drug effect, decreased metabolism/excretion (hepatic and/or renal impairment)

Accumulation of active metabolites

Electrolyte imbalance (hypokalemia, hypocalcemia, hypermagnesemia, hypernatremia)

Hypothermia

Drug interactions

Increased sensitivity to muscle relaxants (eg, neuromuscular disorders such as myasthenia gravis or polymyositis)

Symptoms of overdose include respiratory paralysis, cardiac arrest

Bradyarrhythmias can often be treated with atropine 0.1 mg (infants); do not treat with anticholinesterase drugs (eg, neostigmine, physostigmine) since this may worsen its toxicity by interfering with its metabolism

Increased toxicity: Anticholinesterase drugs (neostigmine, physostigmine, or pyridostigmine) in combination with succinylcholine can cause cardiorespiratory collapse; cyclophosphamide, oral contraceptives, lidocaine, thiotepa, pancuronium, lithium, magnesium salts, aprotinin, chloroquine, metoclopramide, terbutaline, and procaine enhance and prolong the effects of succinylcholine

Prolonged neuromuscular blockade:

Inhaled anesthetics

Local anesthetics

Calcium channel blockers

Antiarrhythmics (eg, quinidine or procainamide)

Antibiotics (eg, aminoglycosides, tetracyclines, vancomycin, clindamycin)

Immunosuppressants (eg, cyclosporine)

Refrigerate (2°C to 8°C/36°F to 46°F); however, remains stable for 14 days unrefrigerated; powder form does not require refrigeration

Stability of parenteral admixture at refrigeration temperature (4°C): 24 hours in D₅W or NS

I.V. form is incompatible when mixed with sodium bicarbonate, pentobarbital, thiopental

Acts similar to acetylcholine, produces depolarization of the motor endplate at the myoneural junction which causes sustained flaccid skeletal muscle paralysis produced by state of accommodation that developes in adjacent excitable muscle membranes

Onset of effect: I.M.: 2-3 minutes; I.V.: Complete muscular relaxation occurs within 30-60 seconds of injection

Duration: I.M.: 10-30 minutes; I.V.: 4-6 minutes with single administration

Metabolism: Rapidly hydrolyzed by plasma pseudocholinesterase

I.M., I.V.:

Older Children and Adolescents: Intermittent: Initial: 1 mg/kg/dose one time; maintenance: 0.3-0.6 mg/kg every 5-10 minutes as needed

Adults: 0.6 mg/kg (range: 0.3-1.1 mg/kg) over 10-30 seconds, up to 150 mg total dose

Maintenance: 0.04-0.07 mg/kg every 5-10 minutes as needed

Continuous infusion: 2.5 mg/minute (or 0.5-10 mg/minute); dilute to concentration of 1-2 mg/mL in D₅W or NS

Note: Pretreatment with atropine may reduce occurrence of bradycardia

Dosing adjustment in hepatic impairment: Dose should be decreased in patients with severe liver disease

May be given by rapid I.V. injection without further dilution

Cardiac monitor, blood pressure monitor, and ventilator required during administration; temperature, serum potassium and calcium, assisted ventilator status

potassium (S)

None reported

MAOIs may prolong the effects of succinylcholine

Refrigerate

Injection, as chloride: 20 mg/mL (10 mL); 50 mg/mL (10 mL); 100 mg/mL (5 mL, 10 mL, 20 mL)

Powder for injection, as chloride: 100 mg, 500 mg, 1 g