Neuromuscular Blockers and Reversals Flashcards
what is Anectine
Succinlycholine
succinylcholine
class/ category
Depolarizing neuromuscular blocker
Succinylcholine
uses
- Intubation
- rapid sequence induction and intubation
- treatment of laryngospasm
succinylcholine
MOA
Postsynaptic Nicotinic M, Acetylcholine agonist
succinlycholine
Doses: intubation and RSI
Intubation: 1 mg/kg TBW
RSI: 1.5 mg/kg TBW
succinlycholine
onest, peak, duration, ED95
Onset: 30-60 sec
Peak: 60 sec
Duration: 5-10 min
ED95: 0.3 mg/kg
succinlycholine
meabolism and active metabolite
Metabolism: Plasma/pseudo/butryl-cholinesterase
Active metabolite: Succinylmonocholine (weakly active, renally excreted)
succinlycholine
CV effects
- Arrhythmias – Bradycardia, junctional rhythm, asystole (most common in pediatrics; likely with repeat dosing); ventricular arrhythmias with stimulation
-Sinus arrest from cardiac M2 stimulation - ↑ HR, ↑ BP
succinlycholine
CNS effects
- ↑ ICP – Preventable with adequate anesthesia and defasciculating dose
- ↑ CBF
- ↑ IOP – Ensure adequate anesthesia
succinlycholine
GI effects
↑ intragastric pressure (does not exceed barrier pressure), ↑ LES pressure –** Does not** increase risk for aspiration
what electrolyte does succinlycholine increase and by how much?
Increases K+ release by 0.5-1 mEq/L in healthy individuals, may be exaggerated by comorbid disease/illness
what muscle spasm may indicate MH?
Masseter muscle spasm – May indicate MH or inadequate dose
T/F succinlycholine can cause fasciculations
TRUE
what could occur 1-2 days post op, what population is it most common with?
Myalgias for 1-2 days postoperatively – Most common in young, ambulatory, females; lower Succinylcholine doses
succinlycholine ay cause myoglobinurina? T/F
and especially with which population?
TRUE
peds
succinlycholine may release this and trigger for what two things?
- Histamine release
- Potential trigger for anaphylaxis
- MH trigger – May present as masseter muscle spasm
succinlycholine contraindications
- Personal or familial history of MH;
- elevated preoperative K+ level
- ≥ 24 hours after injury/disease process associated with immature, extrajunctional ACh receptors (risk for exaggerated K+ release and life-threatening hyperkalemia)
What is the recommendation for succinlychline in regards to open eye injury
Relative contraindications: Open eye injury (anterior chamber)
succinylcholine black box warning
Acute rhabdomyolysis with hyperkalemia → ventricular dysrhythmias, cardiac arrest, and death (in children with undiagnosed skeletal muscle myopathy such as Duchenne muscular dystrophy) – May be used in emergency intubation or instances of necessity to immediately secure airway
Is succinylcholine used routinely in pediatrics?
NO, Not recommended for routine pediatric use
Which patient population has a delayed on set with succinylcholine?
Onset delayed in elderly
T/F-May use in patients with renal failure who have a normal K+ and no uremic neuropathy?
TRUE
is a defasciculating dose of NDNMB relabile to prevent succinlycholine side effects?
Defasciculating dose of NDNMB is unreliable to prevent side effects of Succinylcholine
what is a defasciculating dose of succinlycholine?
If administering a defasciculating dose of NDNMB, increase dose to 1.5-2 mg/kg
Does succinylcholine have a reversal agent?
No reversal agent – not reversible with Suggamadex
