SUCCINYLCHOLINE (ANECTINE)

Class

Short duration, depolarizing neuromuscular blocker

Pharmacology and Actions

1. Succinylcholine is a short-acting, depolarizing skeletal muscle relaxant.
   1. Like acetylcholine, it combines with cholinergic receptors in the motor nerves to cause depolarization.
   2. Neuromuscular transmission is thus inhibited, which renders the muscles unable to be stimulated by acetylcholine.
2. Following IV/IO injection, complete paralysis is obtained within 60-90 seconds and persists for approximately 4 to 5 minutes.
   1. Effects then start to fade, and a return to normal is usually seen within 6 minutes.
   2. Muscle relaxation begins in the eyelids and jaw.
   3. It then progresses to the limbs, the abdomen, and finally the diaphragm and intercostals.
3. It has no effect on consciousness.

Indications

1. Succinylcholine is indicated to achieve temporary paralysis when endotracheal intubation is indicated and muscle tone or seizure activity prevents it.

Contraindications

1. Penetrating eye injury
2. Patients at risk for hyperkalemia (e.g., patients with crush or bum injuries greater than 24 hours old, severe renal failure or known dialysis patient.)
3. Known hypersensitivity to the drug.

Precautions

1. Succinylcholine should not be administered unless personnel skilled in endotracheal intubation are present and ready to perform the procedure.
2. Cardiac arrest and ventricular arrhythmias can occur when Succinylcholine is administered to patients with severe bums and severe crush injuries.

Administration

1. Adult:  100 mg IV/IO push

Side Effects and Special Notes

1. Oxygen therapies and suction should be readily available, as should all emergency resuscitative drugs and equipment.
2. This agent has no effect on consciousness, cerebration or pain threshold. Thus, it is crucial that an analgesic or sedative is administered prior to Succinylcholine.
3. When the airway is secured after Succinylcholine administration and intubation, and further need for neuromuscular blockade is indicated, consider the administration of rocuronium (Zemeron).
4. This agent may increase intragastric pressure, which could result in vomiting and possible aspiration of stomach contents.
5. Lidocaine administration, prior to paralytic administration, reduces the rise in ICP associated with paralytic endotracheal intubation. This is especially important if there is already the possibility of ICP secondary to a head injury.