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Succinylcholine chloride
Succinylcholine chloride (Anectine, Quelicin)
Succinylcholine chloride
(suck-sin-ill-KOH-leen)
Pregnancy Category: C Anectine Anectine Flo-Pack Quelicin Succinylcholine Chloride Min-I-Mix (Rx)

Classification: Depolarizing neuromuscular blocking agent

See Also: See also Neuromuscular Blocking Agents .

Action/Kinetics: Initially excites skeletal muscle by combining with cholinergic receptors preferentially to acetylcholine. Subsequently, it prevents the muscle from contracting by prolonging the time during which the receptors at the neuromuscular junction cannot respond to acetylcholine. The order of paralysis is levator muscles of the eyelid, mastication muscles, limb muscles, abdominal muscles, glottis muscles, the intercostals, the diaphragm, and all other skeletal muscles. Prolonged use may change from a depolarizing neuromuscular block (phase I block) to a block that resembles a nondepolarizing block (phase II block). This may be associated with prolonged respiratory depression and apnea. No effect on pain threshold, cerebration, or consciousness; use with sufficient anesthesia. Effects are not blocked by anticholinesterase drugs and may even be enhanced by them. May cause a change in myocardial rhythm due to vagal stimulation due to surgical procedures (especially in children) and from potassium-mediated alterations in electrical conductivity (enhanced by cyclopropane and halogenated anesthetics). IV: onset, 30-60 sec; duration: 4-6 min; recovery: 8-10 min. IM: Onset, 2-3 min; duration: 10-30 min. Metabolized by plasma pseudocholinesterase to succinylmonocholine, which is a nondepolarizing muscle relaxant, and then to succinic acid and choline. About 10% excreted unchanged in the urine.

Uses: Adjunct to general anesthesia to facilitate ET intubation and to induce relaxation of skeletal muscle during surgery or mechanical ventilation. Investigational: Reduce intensity of electrically induced seizures or seizures due to drugs.

Contraindications: Use in genetically determined disorders of plasma pseudocholinesterase. Personal or family history of malignant hyperthermia. Myopathies associated with elevated CPK values. Acute narrow-angle glaucoma or penetrating eye injuries. Use of IV infusion in children due to the risk of malignant hyperpyrexia.

Special Concerns: Use with caution during lactation. Pediatric clients may be especially prone to myoglobinemia, myoglobinuria, and cardiac effects. Use with caution in clients with severe liver disease, severe anemia, malnutrition, impaired cholinesterase activity, fractures. Also, use with caution in CV, pulmonary, renal, or metabolic diseases. Use with great caution in those with severe burns, electrolyte imbalance, hyperkalemia, those receiving quinidine, and those who are digitalized or recovering from severe trauma, as serious cardiac arrhythmias or cardiac arrest may result. Clients with myasthenia gravis may show resistance to succinylcholine. Those with fractures or muscle spasms may manifest additional trauma due to succinylcholine-induced muscle fasciculations.

Side Effects: Skeletal muscle: May cause severe, persistent respiratory depression or apnea. Muscle fasciculations, postoperative muscle pain. CV: Bradycardia or tachycardia, hypertension, hypotension, arrhythmias, cardiac arrest. Respiratory: Apnea, respiratory depression. Other: Fever, salivation, hyperkalemia, postoperative muscle pain, anaphylaxis myoglobinemia, myoglobinuria, skin rashes, increased intraocular pressure, muscle fasciculation, myalgia, jaw rigidity, perioperative dreams in children, rhabdomyolysis with possible myoglobinuric acute renal failure. Repeated doses may cause tachyphylaxis.
Malignant hyperthermia: Muscle rigidity (especially of the jaw), tachycardia, tachypnea unresponsive to increased depth of anesthesia, increased oxygen requirement and carbon dioxide production, increased body temperature, metabolic acidosis.

Overdose Mangement: Symptoms: Skeletal muscle weakness, decreased respiratory reserve, low tidal volume, apnea. Treatment: Maintain a patent airway and respiratory support until normal respiration is ensured.

Drug Interactions: Aminoglycoside antibiotics / Additive skeletal muscle blockade Amphotericin B / Effect of succinylcholine due to induced electrolyte imbalance Antibiotics, nonpenicillin / Additive skeletal muscle blockade Beta-adrenergic blocking agents / Additive skeletal muscle blockade Chloroquine / Additive skeletal muscle blockade Cimetidine / Cimetidine inhibits pseudocholinesterase Clindamycin / Additive skeletal muscle blockade Cyclophosphamide / Effect of succinylcholine by breakdown of drug in plasma by pseudocholinesterase Cyclopropane / Risk of bradycardia, arrhythmias, sinus arrest, apnea, and malignant hyperthermia Diazepam / Effect of succinylcholine Digitalis glycosides / Chance of cardiac arrhythmias, including ventricular fibrillation Echothiophate iodide / Effect of succinylcholine by breakdown of drug in plasma by pseudocholinesterase Furosemide / Skeletal muscle blockade Halothane / Risk of bradycardia, arrhythmias, sinus arrest, apnea, and malignant hyperthermia Isoflurane / Additive skeletal muscle blockade Lidocaine / Additive skeletal muscle blockade Lincomycin / Additive skeletal muscle blockade Lithium carbonate / Skeletal muscle blockade Magnesium salts / Additive skeletal muscle blockade Narcotics / Risk of bradycardia and sinus arrest Nitrous oxide / Risk of bradycardia, arrhythmias, sinus arrest, apnea, and malignant hyperthermia Oxytocin / Effect of succinylcholine Phenelzine / Effect of succinylcholine Phenothiazines / Effect of succinylcholine Polymyxin / Additive skeletal muscle blockade Procainamide / Effect of succinylcholine Procaine / Effect of succinylcholine by inhibiting plasma pseudocholinesterase activity Promazine / Effect of succinylcholine Quinidine / Additive skeletal muscle blockade Quinine / Additive skeletal muscle blockade Tacrine / Effect of succinylcholine Thiazide diuretics / Effect of succinylcholine due to induced electrolyte imbalance Thiotepa / Effect of succinylcholine by breakdown of drug in plasma by pseudocholinesterase Trimethaphan / Effect of succinylcholine by inhibiting plasma pseudocholinesterase activity

How Supplied: Injection: 20 mg/mL, 50 mg/mL, 100 mg/mL; Powder for injection: 500 mg, 1 g

Dosage
•IM, IV Short or prolonged surgical procedures.
Adults, IV, initial: 0.3-1.1 mg/kg (average: 0.6 mg/kg); then, repeated doses can be given based on client response. Adults, IM: 3-4 mg/kg, not to exceed a total dose of 150 mg.
•IV Infusion (Preferred) Prolonged surgical procedures.
Adults: Average rate ranges from 2.5 to 4.3 mg/min. Most commonly used are 0.1%-0.2% solutions in 5% dextrose, sodium chloride injection, or other diluent given at a rate of 0.5-10 mg/min depending on client response and degree of relaxation desired, for up to 1 hr.
•Intermittent IV Prolonged muscle relaxation.
Initial: 0.3-1.1 mg/kg; then 0.04-0.07 mg/kg at appropriate intervals to maintain required level of relaxation.
•IM, IV Electroshock therapy.
Adults, IV: 10-30 mg given 1 min prior to the shock (individualize dosage). IM: Up to 2.5 mg/kg, not to exceed a total dose of 150 mg.
ET intubation.
Pediatric, IV: 1-2 mg/kg; if necessary, dose can be repeated. IM: 3-4 mg/kg, not to exceed a total dose of 150 mg.