Succinylcholine (Quelicin, Anectine)

Category:

  • Muscle relaxant

  Description:

  • Nondepolarizing skeletal muscle relaxant

  Indications:

  • Adjunct to general anesthesia to facilitate intubation and skeletal muscle relaxation

  Contraindications:

  • Patients with genetically determined disorders of plasma pseudocholinesterase

  • Personal or family history of malignant hyperthermia

  • Myopathies associated with elevated creatine phosphokinase values

  • Acute narrow-angle glaucoma

  • Penetrating eye injuries

Precautions:

  • Pregnancy category C

  • Only used by skilled personnel in airway management and respiratory support.

  • Must have anticholinesterase reversal agents immediately available during use.

  • Use with caution in patients with cardiovascular, hepatic, pulmonary, metabolic or renal dysfunction.

  • Use with caution in patients with severe burns and electrolyte imbalances.

  • Prolonged blockade may occur in patients who are hypokalemic, hypocalcemic, or having hepatic, cardiovascular or pulmonary disorders.

  • Produces a slight, transient increase in intraocular and intracranial pressure.

  • May cause malignant hyperthermia in susceptible patients.

  • Will cause histamine release.  Use with caution in patients susceptible to histamine, such as cardiovascular disease and asthma.

  • Contains benzyl alcohol that may cause “gasping syndrome” in premature infants.

  • May cause bradycardia during anesthesia.

  • Use with caution in patients with neuromuscular disease.

  • Use a peripheral nerve stimulator to monitor twitch suppression and recovery.

  Adverse Reactions (Side Effects):

  • Cardiovascular: hypotension, vasodilation, tachycardia, bradycardia, cardiac arrest

  • Respiratory depression and apnea

  • Malignant hyperthermia, increased intraocular pressure, muscle twitching, post-operative muscle pain

  • Excessive salivation

Dosage:

· Administered via IV or IM injection

· Initiate therapy only after patient is unconscious.

· Short surgery: 0.6mg/kg IV (paralysis lasts 2 minutes, recovery 4-6 minutes)

· Long surgery: 2.5-4.3mg/min (commonly 1-2mg/mL infused as constant IV drip)

· Prolonged relaxation (mechanical ventilation): 0.3-1.1mg/kg initial, then 0.04-0.07mg/kg administered to maintain relaxation as IV infusion

· Children:

  - young children: 2mg/kg IV

  - older children: 1mg/kg IV

  - IM (in absence of suitable vein): 3-4mg/kg (not to exceed 150mg)

 
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