Paralytics: Succinylcholine / Anectine

Question 1

Who was the first to successfully use curare for surgical relaxation in an anesthetized patient, and in what year did this occur?

A) Enid Johnson in 1942
B) Harold Griffith in 1942
C) Arthur Läwen in 1912
D) Alexander Wood in 1843

Answer 1

C) Arthur Läwen in 1912

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Question 2

In what year did neuromuscular blocking drugs become commonly used in surgery due to their effectiveness in muscle relaxation?

A) 1500s
B) 1912
C) 1942
D) 1980s

Answer 2

C) 1942

Enid Johnson, following Canadian anesthesiologist Harold Griffith’s instructions, used it in Montreal for a patient undergoing appendectomy

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Question 3

How does Succinylcholine work at the neuromuscular junction (NMJ)?

A) It inhibits acetylcholinesterase, increasing ACH levels.
B) It blocks potassium channels to prevent depolarization.
C) It binds to ACH receptors and mimics ACH, causing depolarization of the motor end plate.
D) It antagonizes ACH receptors to prevent muscle contraction.

Answer 3

C) It binds to ACH receptors and mimics ACH, causing depolarization of the motor end plate.

It stays there and keeps the channel open – the receptor can not reset and the muscle is paralyzed

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Question 4

Succinylcholine acts on which types of receptors?

A) Only postsynaptic receptors
B) Only presynaptic receptors
C) Presynaptic, postsynaptic, and extrajunctional receptors
D) Only inhibitory receptors

Answer 4

C) Presynaptic, postsynaptic, and extrajunctional receptors

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Question 5

What effect does prolonged contact between Succinylcholine and the receptor cause?

A) Hypersensitivity of the receptor
B) Increased muscle contractions
C) Desensitization of the receptor
D) Decreased acetylcholinesterase activity

Answer 5

C) Desensitization of the receptor

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Question 6

The action of Succinylcholine is antagonized by ___ and augmented by ___.

A) Potassium, magnesium
B) Non-depolarizers, acetylcholinesterase
C) Calcium, epinephrine
D) ACH inhibitors, ACH receptors

Answer 6

B) Non-depolarizers, acetylcholinesterase

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Question 7

What is the typical onset of action for Succinylcholine?

A) 5-10 seconds
B) 30-60 seconds
C) 2-3 minutes
D) 5-10 minutes

Answer 7

B) 30-60 seconds

Memory trick: “It will SUX in 30 to 60 seconds”

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Question 8

How long does the duration of action of Succinylcholine typically last?

A) 1-2 minutes
B) 3-5 minutes
C) 7-10 minutes
D) 15-20 minutes

Answer 8

C) 7-10 minutes

Memory trick: “It will SUX for 7 to 10 minutes”

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Question 9

Which of the following is true regarding Succinylcholine?

A) Succinylcholine is safe to use in patients with a family history of MH.
B) Succinylcholine is a known trigger for MH.
C) Succinylcholine can prevent MH when given with anesthetic agents.
D) Succinylcholine has no effect on MH.

Answer 9

B) Succinylcholine is a known trigger for MH (Malignant Hyperthermia)

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Question 10

Succinylcholine is dangerous for use in which group(s) of patients due to the risk of hyperkalemia? (Select 3 that apply)

A) Patients with asthma
B) Patients with burns
C) Patients with paralysis
D) Patients with renal failure
E) Patients with high blood pressure

Answer 10

B) Patients with burns

C) Patients with paralysis

D) Patients with renal failure

Suxx increases potassium levels and can result in arrhythmias, and arrest.

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Question 11

Succinylcholine is considered the gold standard for which of the following clinical applications? (Select 2 that apply)

A) Rapid Sequence Induction (RSI)
B) Long-term muscle relaxation in ICU patients
C) Difficult airway manipulation
D) Chronic management of muscle spasms

Answer 11

A) Rapid Sequence Induction (RSI)
C) Difficult airway manipulation

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Question 12

Put it all together

1. Succinylcholine binds to the ___ receptors at the NMJ, mimicking ___ to cause depolarization of the motor end plate.
2. Succinylcholine depolarizes ___, ___, and ___ receptors.
3. Prolonged contact between Succinylcholine and the receptor provides ___.
4. Succinylcholine is antagonized by ___.
5. The action of Succinylcholine is augmented by ___.
6. The onset of action of Succinylcholine is ___ seconds.
7. The duration of action for Succinylcholine is ___ minutes.
8. Succinylcholine increases ___ levels, which can result in ___ and ___.
9. Succinylcholine poses a danger when used in patients with __ , __ , or __ , due to the risk of hyperkalemia and potential for serious complications.
10. Succinylcholine is a known trigger for ___.
11. Succinylcholine is considered the gold standard for ___ due to its rapid onset and excellent intubating conditions within 60 seconds.

Answer 12

1. ACH, acetylcholine
2. presynaptic, postsynaptic, extrajunctional
3. desensitization
4. non-depolarizers
5. acetylcholinesterase
6. 30-60 seconds
7. 7-10 minutes
8. potassium, arrhythmias, arrest
9. burns, paralysis, renal failure
10. Malignant Hyperthermia (MH)
11. Rapid Sequence Induction (RSI)

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Question 13

dose of succinylcholine
A. 1-1.5mg/kg
B. 1-2mg/kg
C.1.5-2mg/kg
D.0.5-1mg/kg

Answer 13

A. 1-1.5mg/kg

Question 14

how many mg of succinylcholine per mL
A.5
B.15
C.20
D. 10

Answer 14

C. 20