Succinylcholine

• Clinical Indications
  • Rapid sequence intubation
    • 1.5–2.0 mg/kg IV
  • Intubation
    • 1.0–1.5 mg/kg IV (Figure 5.16)
  • Laryngospasm
    • 4 mg/kg IM
    • 0.1–2.0 mg/kg IV
      • Depending on degree of hypoxia, age, and comorbidities
• Cerebral
  • Minimal
• Cardiac
  • ↑ Risk of severe bradycardia in pediatrics, especially with second dose
• Pulmonary
  • ↓ RR
  • ↓ TV
  • Respiratory arrest
• Renal
  • Minimal
• Hepatic
  • Minimal
• Contraindications
  • Chronic trauma
    • Stroke
    • Burns
    • Spinal cord injuries
    • Debatable on how long the injury must be present to have hyperkalemic effects
  • Hyperkalemia
  • Parkinson’s disease [61]
  • Muscular dystrophy
  • Malignant hyperthermia risk
  • Pseudocholinesterase deficiency
  • Emergency use only in pediatrics, with special precautions to males younger than age eight years of age, due to possibly undiagnosed muscular dystrophy and subsequent hyperkalemia
• Board Facts
  • Ok to use for open eye injuries [62]
  • Ok to use with cerebral palsy [63]
  • Dose on total body weight [64]
  • Muscle pain secondary to fasciculations
  • Metabolized by pseudocholinesterase
  • Pseudocholinesterase deficiency
    • Can do a clinical test which is measured by dibucaine and this measures the % amount that dibucaine can inhibit pseudocholinesterase
      • >80% inhibition
        • Normal
        • ~5‐minute block
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