What is Succinylcholine? 1
- A depolarizing neuromuscular blocking drug
- Commonly used for rapid sequence induction and intubation due to its rapid onset and ultra-short duration of action.
- Succinylcholine has very important contraindications
Mechanism of Action & Pharmacokinetics 1
- Mimics acetylcholine by binding to nicotinic receptors at the neuromuscular junction, causing an initial depolarization (muscle fasciculations) followed by sustained depolarization, leading to paralysis.
- Onset of action is typically 30-60 seconds, with peak effect occurring within 1 minute.
- Duration of action is approximately 5-10 minutes due to rapid hydrolysis by plasma cholinesterase (pseudocholinesterase).
Pharmacodynamics 1
Cardiovascular
- Minimal direct cardiovascular effects, but may cause bradycardia, particularly in pediatric patients or with repeated dosing.
Respiratory
- Causes complete paralysis of respiratory muscles, requiring assisted ventilation until the drug wears off.
Neurological
- Can cause increased intracranial pressure (ICP) transiently.
Indications 1
-
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and intubation. - Situations requiring quick onset of muscle paralysis.
Dosage 2
- Intubation Dose: 1-1.5 mg/kg IV based on total body weight (TBW).
- Intramuscular Dose: 3-4 mg/kg IM based on total body weight (TBW).
Contraindications 1
- History of malignant hyperthermia.
- Hyperkalemia or conditions that predispose to hyperkalemia (e.g., burns, severe trauma, spinal cord injuries).
- History of myopathies associated with elevated creatine kinase (CK) levels.
Complications 1
- Bradycardia, especially with repeated doses in pediatric patients.
- Hyperkalemia
- Malignant hyperthermia in susceptible individuals.
- Fasciculations, which can cause postoperative myalgias.