Succinylcholine

Contraindications

1. Known hyperK (current)
2. Massive burns >10% BSA (>4dys-healed)
3. Massive crush injuries (>4dys-healed)
4. Denervation^ (>4dys-6mo)
5. Neuromuscular dz^^ (indefinite)
6. Intra-abdominal sepsis (>5dys-resolution)
7. Increased ICP (may use w/ defacic dose)

(From-To) ^CVA (in particular those with residual deficits), spinal cord injury

^^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.

Source

2/06 DONALDSON (Adapted from Rosen)

Levitan, R. Annals of EM. Vol 45, Issue 2. Safety of succinylcholine in myasthenia gravis.