Dosing and uses of Anectine, suxamethonium (succinylcholine)
Adult dosage forms and strengths
injectable solution
- 20mg/mL
- 100mg/mL
Load
0.3-1.1 mg/kg IV x1 dose, Or
3-4 mg/kg IM x1 dose
Short Procedures: usually 0.6 mg/kg IV injection
Maint for Prolonged Procedures
- 0.04-0.07 mg/kg IV q5-10min PRN OR
- 2.5 mg/min IV infusion
Other Information
Dose should be calculated based on ideal body weight
Pretreatment: atropine may reduce vagally mediated bradycardia/hypotension/drooling
Solution contains 1% benzyl alcohoL
Prior administration of "defasciculating" dose of nondepolarizing neuromuscular blocker (such as 0.01 mg/kg IV vecuronium) will prevent muscular fasciculations that may incr ICP/IOp
Adequate ventilatory support mandatory, may experience incr sensitivity with electrolyte disorders (hyperMg, hypoK, hypoCa)
Other Indications & Uses
Adjunct to general anesthesia-induce muscle relaxation for endotracheal intubation, endoscopic examinations, orthopedic procedures
Pediatric dosage forms and strengths
injectable solution
- 20mg/mL
- 100mg/mL
Load
1-2 mg/kg IV x1 dose
3-4 mg/kg deep IM x1 dose (no adequate IV)
Other Information
Higher dose generally if <6 years old; maintenance:0.3-0.6 mg/kg IV q5-10min PRn
Anectine, suxamethonium (succinylcholine) adverse (side) effects
Frequency not defined
Muscle fasciculation which may result in postoperative pain
Jaw rigidity
Apnea
Respiratory depression
Bradycardia
Hypotension
Cardiac arrhythmias
Sinus tachycardia
Incr IOp
Salivary gland enlargement
Excessive salivation
Rash
Hypersensitivity reactions
Malignant hyperthermia
Myoglobinuria/myoglobinemia (rare)
Warnings
Black box warnings
Rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death after the administration of succinylcholine to apparently healthy children have been reported in children and adolescents. The children were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne's muscular dystrophy. It occurs soon after administration and requires immediate treatment of hyperkalemia. Prolonged resuscitation may be required.
Reserve for use in children for emergency intubation or in instances when immediate securing of airway is necessary. It should be administered by trained personnel with a facility equipped to monitor, assist, and control respiration.
Contraindications
Malignant hyperthermia, lack of ventilatory support, ocular surgery, penetrating eye injuries, closed-angle glaucoma, genetically determined disorders of plasma pseudocholinesterase, history of malignant hyperthermia, myopathies associated with elevated serum creatine kinase
Cautions
Severe anaphylactic reactions to neuromuscular blocking agents have been reported; these reactions have, in some cases, been life threatening and fatal; because of the potential severity of these reactions, the necessary precautions, such as the immediate availability of appropriate emergency treatment, should be taken
Chronic abdominal infection, subarachnoid hemorrhage, degenerative or dystrophic neuromuscular dz, conditions that may cause degeneration of central & peripheral nervous systems, upper motor neuron injury, multiple trauma, extensive denervation of skeletal muscle, electrolyte imbalance, glaucoma/eye injury (increases IOP)
Pts with atypical or deficient pseudocholinesterase will have prolonged paralysis (such as organophosphate/carbamate poisoning, hyperthermia, burn patient, collagen-vascular disease)
Additive/synergistic effects if administered with or following an opioid, sedative or anesthetic agent
Acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, & death have been reported rarely in apparently healthy children & adolescents
Repeated fractional doses or (to a lesser extent) continuous infusion may lead to tachyphylaxis
Pregnancy and lactation
Pregnancy category: C
Lactation: not known if excreted in breast milk; effect on nursing infant not known
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Anectine, suxamethonium (succinylcholine)
Onset: IV: 30-60 sec; IM: 2-3 min
Duration: IV 2-10 min; IM 10-30 min
Metabolism: rapid, by plasma pseudocholinesterase to weakly active metabolite
Metabolites: succinylmonocholine & choline
Excretion: urine
Pharmacogenomics
Increased incidence of malignant hyperthermia with use of volatile anesthetics or depolarizing neuromuscular blockers in patients with gene mutations in ryanodine receptor (RYR1) or calcium channel alpha (1S)- subunit gene (CACNA1S)
Mechanism of action
Depolarizing skeletal muscle relaxant; no effect on consciousness, pain
Administration
IV Incompatibilities
Additive: methohexital, nafcillin, pentobarbital, sodium bicarbonate, thiopentaL
Y-site: methohexital, thiopentaL
IV Compatibilities
Solution: compatible with most common solvents
Additive: amikacin, isoproterenol, meperidine, methyldopate, morphine, norepinephrine, scopolamine
Syringe: heparin
Y-site: etomidate, heparin/hydrocortisone, Hextend, KCl, propofol, vit B/C
IV Preparation
Cont Infusion: dilute to 1-2 mg/mL w/ D5W, D5/NS, NS or Na-lactate 1/6m
IV/IM Administration
IM: IM injections should be made deeply, preferably high into deltoid muscle
IV: may be given by rapid IV injection (10-30 sec) without further dilution
Cont IV infusion: 2.5 mg/min (range: 0.5-10 mg/min)
Storage
Refrigerate at 2-8°C (36-46°F)
Powder form does not require refrigeration
