Succinylcholine: Difference between revisions

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==Contraindications==
''See [[critical care quick reference]] for drug doses by weight.''


==General==
*Type: [[Neuromuscular blocker]]
*Dosage Forms: IV or IM
*Common Trade Names: Anectine; Quelicin; Quelicin-1000


1)  Known hyperK    (current)
==Adult Dosing==
*1.0-1.5mg/kg IV
*Increase dose in cases of shock
*4mg/kg IM (in extremis)


2)  Massive burns >10% BSA    (>4dys-healed)
==Pediatric Dosing==
''See [[critical care quick reference]] for drug doses by weight.''


3)  Massive crush injuries    (>4dys-healed)
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*Lactation: Unknown if compound is excreted in breast milk
*Renal Dosing
**Adult: None specified by manufacturer
**Pediatric
*Hepatic Dosing
**Adult: None specified by manufacturer
**Pediatric


4)  Denervation*       (>4dys-6mo)
==Contraindications==
 
*[[Hyperkalemia]]
5)  Neuromuscular dz**   (indefinite)
*Preexisting hyperkalemia
 
*[[Rhabdomyolysis]]
6)  Intra-abdominal sepsis    (>5dys-resolution)
*Burns, crush injuries, spinal cord injuries, strokes, and intraabdominal sepsis >5 days old<ref>Gronert GA. "Succinylcholine Hyperkalemia after Burns." Anesthesiology 7 1999, Vol.91, 320.</ref><ref>Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. St. Louis, MO: Elsevier; 2014: 855-871.</ref><ref>Tintinalli JE, Stapczynski JS, Ma OJ, et al, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill; 2012: 1620-1621.</ref>
 
*Neuromuscular diseases, e.g., multiple sclerosis, amyotrophic lateral sclerosis, myasthenia gravis myopathies
7)  Increased ICP  (may use w/ defacic dose)
*[[Myopathies]]
 
*spinal cord damage (1 week - 3 months old)
(From-To)
*History of [[Malignant Hyperthermia]]
 
*Immobilization, including found down with unknown time
*CVA (in particular those with residual deficits), spinal cord injury
*Allergy to class/drug
 
*Tetanus, botulism, and other exotoxin infections
**ALS, MS, skeletal muscle myopathies, cholinesterase def, h/o malignant hyperthermia
 
-no evidence to support contraindication in penetrating eye injuries-
 
 
N.B. Myasthenia Gravis- theoretically need more succ to induce vs nondepolarizing agents which have a prolonged effect.
 
This is 2/2 to lack of post-synaptic receptors, i.e. succ cannot potentiate a reaction 2/2 too few receptors.
 
Vs. it takes few "molecules" of roc/vec to block the few remaining functioning receptors.
 
Overall, most practitioners tend to avoid succ in all patients with possible neuromuscular disease.


==Conditions Requiring Decreased Dosing==
*[[Organophosphate toxicity]]
*[[Eaton-Lambert Syndrome]]
*[[Hypothyroidism]]


==Source ==
==Use in Myesthenia Gravis==
Increased dosing required for patients with [[Myasthenia gravis]] due to the destruction of nicotinic receptors from auto-antibodies *
*Anestheia literature supports increased dose of 2.0mg/kg<ref>Eisenkraft JB et al. Resistance to succinylcholine in myasthenia gravis: a dose-response study. Anesthesiology. 1988 Nov;69(5):760-3</ref>
*There is no evidence to support claims of increased hyperkalemia<ref>Levitan R. Safety of succinylcholine in myasthenia gravis. Ann Emerg Med. 2005 Feb;45(2):225-6.</ref>
*If the patient is on a cholinesterase inhibitor there will be prolonged effect of the paralytic.<ref>Dillon FX. Anesthesia issues in the perioperative management of myasthenia gravis. Semin Neurol. 2004 Mar;24(1):83-94. Review.</ref>


==Adverse Reactions==
===Serious===
*Fatal hyperkalemia
*Malignant hyperthermia
*Masseter spasm


2/06  DONALDSON (Adapted from Rosen)
===Common===


Levitan, R. Annals of EM. Vol 45, Issue 2. Safety of succinylcholine in myasthenia gravis.
==Pharmacology==
*Structure of two acetylcholine molecules linked through acetate methyl groups
*Onset: IV: 30-60 seconds; IM: 2-3 minutes
*Metabolism: Plasma pseudocholinesterase hydrolysis
*Excretion: Urine
*Mechanism of Action: Depolarization of the myoneural junction motor endplate
*Duration of Action: IV: 4-6 minutes; IM 10-30 minutes


==See Also==
*[[Malignant Hyperthermia]]
*[[Critical care quick reference]]
*[[Rocuronium]]


{{Template:Related Difficult Airway Pages}}


==References==
*Levitan, R. Annals of EM. Vol 45, Issue 2. Safety of succinylcholine in myasthenia gravis.
<references/>


[[Category:Drugs]]
[[Category:Pharmacology]]
[[Category:Critical Care]]

Latest revision as of 20:03, 20 February 2021

See critical care quick reference for drug doses by weight.

General

Adult Dosing

  • 1.0-1.5mg/kg IV
  • Increase dose in cases of shock
  • 4mg/kg IM (in extremis)

Pediatric Dosing

See critical care quick reference for drug doses by weight.

Special Populations

  • Pregnancy Rating: C
  • Lactation: Unknown if compound is excreted in breast milk
  • Renal Dosing
    • Adult: None specified by manufacturer
    • Pediatric
  • Hepatic Dosing
    • Adult: None specified by manufacturer
    • Pediatric

Contraindications

  • Hyperkalemia
  • Preexisting hyperkalemia
  • Rhabdomyolysis
  • Burns, crush injuries, spinal cord injuries, strokes, and intraabdominal sepsis >5 days old[1][2][3]
  • Neuromuscular diseases, e.g., multiple sclerosis, amyotrophic lateral sclerosis, myasthenia gravis myopathies
  • Myopathies
  • spinal cord damage (1 week - 3 months old)
  • History of Malignant Hyperthermia
  • Immobilization, including found down with unknown time
  • Allergy to class/drug
  • Tetanus, botulism, and other exotoxin infections

Conditions Requiring Decreased Dosing

Use in Myesthenia Gravis

Increased dosing required for patients with Myasthenia gravis due to the destruction of nicotinic receptors from auto-antibodies *

  • Anestheia literature supports increased dose of 2.0mg/kg[4]
  • There is no evidence to support claims of increased hyperkalemia[5]
  • If the patient is on a cholinesterase inhibitor there will be prolonged effect of the paralytic.[6]

Adverse Reactions

Serious

  • Fatal hyperkalemia
  • Malignant hyperthermia
  • Masseter spasm

Common

Pharmacology

  • Structure of two acetylcholine molecules linked through acetate methyl groups
  • Onset: IV: 30-60 seconds; IM: 2-3 minutes
  • Metabolism: Plasma pseudocholinesterase hydrolysis
  • Excretion: Urine
  • Mechanism of Action: Depolarization of the myoneural junction motor endplate
  • Duration of Action: IV: 4-6 minutes; IM 10-30 minutes

See Also

Airway Pages

References

  • Levitan, R. Annals of EM. Vol 45, Issue 2. Safety of succinylcholine in myasthenia gravis.
  1. ↑ Gronert GA. "Succinylcholine Hyperkalemia after Burns." Anesthesiology 7 1999, Vol.91, 320.
  2. ↑ Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. St. Louis, MO: Elsevier; 2014: 855-871.
  3. ↑ Tintinalli JE, Stapczynski JS, Ma OJ, et al, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill; 2012: 1620-1621.
  4. ↑ Eisenkraft JB et al. Resistance to succinylcholine in myasthenia gravis: a dose-response study. Anesthesiology. 1988 Nov;69(5):760-3
  5. ↑ Levitan R. Safety of succinylcholine in myasthenia gravis. Ann Emerg Med. 2005 Feb;45(2):225-6.
  6. ↑ Dillon FX. Anesthesia issues in the perioperative management of myasthenia gravis. Semin Neurol. 2004 Mar;24(1):83-94. Review.
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