SUCCINYLCHOLINE CHLORIDE

(suk-sin-ill-koe'leen)

Anectine, Quelicin
Classifications: depolarizing skeletal muscle relaxant;
Therapeutic: depolarizing skeletal muscle relaxant
Pregnancy Category: C

Availability

20 mg/mL, 50 mg/mL, 100 mg/mL injection

Action

Synthetic, ultrashort-acting depolarizing neuromuscular blocking agent with high affinity for acetylcholine (ACh) receptor sites.

Therapeutic Effect

Initial transient contractions and fasciculations are followed by sustained flaccid skeletal muscle paralysis produced by state of accommodation that develops in adjacent excitable muscle membranes.

Uses

To produce skeletal muscle relaxation as adjunct to anesthesia; to facilitate intubation and endoscopy, to increase pulmonary compliance in assisted or controlled respiration, and to reduce intensity of muscle contractions in pharmacologically induced or electroshock convulsions.

Contraindications

Hypersensitivity to succinylcholine; family history of malignant hyperthermia; burns; trauma; pregnancy (category C).

Cautious Use

During delivery by cesarean section; lactation; kidney, liver, pulmonary, metabolic, or cardiovascular disorders; myasthenia gravis; dehydration, electrolyte imbalance, patients taking digitalis, severe burns or trauma, fractures, spinal cord injuries, degenerative or dystrophic neuromuscular diseases, low plasma pseudocholinesterase levels (recessive genetic trait, but often associated with severe liver disease, severe anemia, dehydration, marked changes in body temperature, exposure to neurotoxic insecticides, certain drugs); collagen diseases, porphyria, intraocular surgery, glaucoma; lactation.

Route & Dosage

Surgical and Anesthetic Procedures
Adult: IV 0.3–1.1 mg/kg administered over 10–30 sec, may give additional doses prn IM 2.5–4 mg/kg up to 150 mg
Child: IV 1–2 mg/kg administered over 10–30 sec, may give additional doses prn IM 2.5–4 mg/kg up to 150 mg

Prolonged Muscle Relaxation
Adult: IV 0.5–10 mg/min by continuous infusion

Obesity
Dose based on IBW.

Administration

Intramuscular

Give IM injections deeply, preferably high into deltoid muscle.

Intravenous

Use only freshly prepared solutions; succinylcholine hydrolyzes rapidly with consequent loss of potency.
Give initial small test dose (0.1 mg/kg) to determine individual drug sensitivity and recovery time.

PREPARE: Direct: Give undiluted. Intermittent/Continuous: Dilute 1 g in 500–1000 mL of D5W or NS.

ADMINISTER: Direct: Give a bolus dose over 30 sec. Intermittent/Continuous: Preferred. Give at a rate of 0.5–10 mg/min. Do not exceed 10 mg/min.

INCOMPATIBILITIES Solution/additive: Aminophylline, ampicillin, cephalothin, diazepam, epinephrine, hydrocortisone, methicillin, methohexital, nitrofurantoin, oxacillin, oxytetracycline, sodium bicarbonate, thiopental, warfarin. Y-site: Thiopental.

Note: Expiration date and storage before and after reconstitution; varies with the manufacturer.

Adverse Effects (≥1%)

CNS: Muscle fasciculations, profound and prolonged muscle relaxation, muscle pain. CV: Bradycardia, tachycardia, hypotension, hypertension, arrhythmias, sinus arrest. Respiratory: Respiratory depression, bronchospasm, hypoxia, apnea. Body as a Whole: Malignant hyperthermia, increased IOP, excessive salivation, enlarged salivary glands. Metabolic: Myoglobinemia, hyperkalemia. GI: Decreased tone and motility of GI tract (large doses).

Interactions

Drug: Aminoglycosides, colistin, cyclophosphamide, cyclopropane, echothiophate iodide, halothane, lidocaine, magnesium salts, methotrimeprazine, narcotic analgesics, organophosphamide insecticides, mao inhibitors, phenothiazines, procaine, procainamide, quinidine, quinine, propranolol may prolong neuromuscular blockade; digitalis glycosides may increase risk of cardiac arrhythmias.

Pharmacokinetics

Onset: 0.5–1 min IV; 2–3 min IM. Duration: 2–3 min IV; 10–30 min IM. Distribution: Crosses placenta in small amounts. Metabolism: In plasma by pseudocholinesterases. Elimination: In urine.

Nursing Implications

Assessment & Drug Effects

Lab tests: Obtain baseline serum electrolytes. Electrolyte imbalance (particularly potassium, calcium, magnesium) can potentiate effects of neuromuscular blocking agents.
Be aware that transient apnea usually occurs at time of maximal drug effect (1–2 min); spontaneous respiration should return in a few seconds or, at most, 3 or 4 min.
Have immediately available: Facilities for emergency endotracheal intubation, artificial respiration, and assisted or controlled respiration with oxygen.
Monitor vital signs and keep airway clear of secretions.

Patient & Family Education

Patient may experience postprocedural muscle stiffness and pain (caused by initial fasciculations following injection) for as long as 24–30 h.
Be aware that hoarseness and sore throat are common even when pharyngeal airway has not been used.
Report residual muscle weakness to physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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