Succinylcholine

See critical care quick reference for drug doses by weight.

General

Adult Dosing
  • 1.5mg/kg IV
  • 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
  • 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

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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