Succinylcholine

Question 1

What is the trade name for succinylcholine?

Answer 1

Anectine

Question 2

What is the drug classification of succinylcholine (Anectine)?

Answer 2

Depolarizing neuromuscular blocking agent

Question 3

How is succinylcholine (Anectine) supplied?

Answer 3

20 mg/mL, 50 mg/mL, and 100 mg/mL vials

Question 4

Describe the MOA (pharmacodynamics) of succinylcholine (Anectine).

Answer 4

It’s similar to acetylcholine (Ach) and so produces depolarization at the myoneural junction. Due to it’s high affinity for Ach receptor sites, and resistance to acetylcholinesterase, the depolarization is prolonged and so induces paralysis. It also possesses histamine-releasing properties.

Question 5

What are the indications for succinylcholine (Anectine)?

Answer 5

Medication facilitated intubation after administration of sedation/analgesia; considered agent of choice due to short duration and rapid onset

Question 6

What is the ADULT dose for succinylcholine (Anectine)?

Answer 6

1 - 1.5 mg/kg IVP, repeat at half dose if required
(AHS Protocol 1.5mg/kg to max 150mg)

If repeat dose is required, administer Atropine 0.5 mg to inhibit bradycardia response.

Question 7

What is the pediatric dose for succinylcholine (Anectine)?

Answer 7

2mg/kg IVP, no repeat as second dose can cause bradycardia. No AHS protocol for peds.

Question 8

List contraindications for succinylcholine (Anectine).

Answer 8

• Hypersensitivity
• Penetrating ocular trauma or glaucoma
• Pseudocholinesterase deficiency
• Known family or personal history of malignant hyperthermia
  ❑ Patients in whom hyperkalemia may be dangerous:
• chronic renal failure with unknown potassium levels
• patients with spastic muscles (eg. muscular dystrophy, spastic paralysis)
• burn and crush injury patients after 24hrs post injury
  ❑ A difficult intubation in a patient who is presently self ventilating adequately and ventilation may be difficult once paralyzed

Question 9

What is a precaution for succinylcholine?

Answer 9

Has no sedative or analgesic properties (sedation must be given first).

Question 10

What is a common mistake in MFI?

Answer 10

Not allowing adequate time for the paralytic to take effect

Question 11

How long must you keep ventilating a patient while a succinylcholine wears off?

Answer 11

The diaphragm recovers before the muscle relaxant is completely worn off. Therefore, you must continue to ventilate the patient for at least 10 minutes after breathing is resumed. Assess adequacy of tidal volume before allowing the patient to breathe unassisted.

Question 12

You gave succinylcholine and now your patient is presenting with Malignant hyperthermia. What drug is given at hospital to reverse this?

Answer 12

Dantrolene