Generic Name

Succinylcholine Chloride

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Classification

FDA Approved Indications

• Facilitation of endotracheal intubation during anesthesia
• Adjunct to general anesthesia to relax skeletal muscles during surgery, mechanical ventilation, and endoscopy

Mechanism of Action

Succinylcholine acts as an agonist at the nicotinic acetylcholine receptors at the neuromuscular junction, causing persistent depolarization of the motor endplate and reduced muscle contraction, leading to paralysis.

Dosage and Administration

Adult: 0.6 to 1.1 mg/kg IV for intubation; repeat doses as needed, based on clinical response

Pediatric: 1 to 1.5 mg/kg IV for intubation; doses may vary depending on age and weight

Geriatric: Dose adjustments are generally not necessary but should be based on clinical condition and response

Renal Impairment: Monitor closely; dose adjustments may be necessary due to altered drug clearance

Hepatic Impairment: Use with caution; no specific adjustments but monitor for prolonged paralysis

Pharmacokinetics

Absorption: Not applicable (administered IV)

Distribution: Distributed rapidly to neuromuscular junctions and tissues

Metabolism: Minimal hepatic metabolism; primarily hydrolyzed by plasma pseudocholinesterase

Excretion: Primarily excreted unchanged in urine via plasma pseudocholinesterase activity

Half Life: Approx. 1 to 10 minutes

Contraindications

• History of malignant hyperthermia
• Known hypersensitivity to succinylcholine or other neuromuscular blockers
• Prior history of hyperkalemia or risk factors for hyperkalemia

Precautions

• Risk of hyperkalemia, especially in burns, crush injuries, severe infections, or neuromuscular diseases; or in children with undiagnosed muscular dystrophy
• Can cause increased intraocular pressure, increased intracranial pressure, or severe bradycardia

Adverse Reactions - Common

• Muscle fasciculations (Common)
• Malignant hyperthermia (Rare but serious)
• Hyperkalemia (Potential in certain populations)
• Prolonged paralysis (Rare)
• Myalgia after recovery (Common)

Adverse Reactions - Serious

• Anaphylaxis (Rare)
• Cardiac arrhythmias (Rare)
• Increased intraocular or intracranial pressure (Rare)

Drug-Drug Interactions

• Inhalational anesthetics (risk of malignant hyperthermia)
• Agents that increase plasma pseudocholinesterase activity (can decrease effectiveness)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Inform about the temporary paralysis and that it will resolve after the drug wears off
• Advise on the importance of informing healthcare providers about succinylcholine use in case of anesthesia or surgery
• Report any muscle pain, difficulty breathing, or unusual signs immediately

Special Considerations

Black Box Warnings:

• Potential for hyperkalemia leading to cardiac arrest, especially in children and certain neurological conditions

Genetic Factors: Pseudocholinesterase deficiency can prolong paralysis

Lab Test Interference: May interfere with cholinesterase activity assays

Overdose Management

Signs/Symptoms: Prolonged paralysis, hyperkalemia, arrhythmias, malignant hyperthermia

Treatment: Supportive care; administer anti-hyperkalemic agents if needed; treat hyperthermia aggressively; use dantrolene for malignant hyperthermia; long-term paralysis may require mechanical ventilation

Storage and Handling

Storage: Store at room temperature away from light and moisture

Stability: Stable until expiration date when stored properly