Page 174 - 2026 SMOG

SUCCINYLCHOLINE (ANECTINE)
Class/Mechanism of Action
• Depolarizing Neuromuscular Blocking Agent (Paralytic)
Acts like acetylcholine. Produces myoneural depolarization, causing sustained flaccid skeletal
muscle paralysis.
˚ Onset of action—IV: 30–60sec; Duration—IV: 4–10min with single dose
Indications
• Labeled Indications
˚ Rapid Sequence Intubation and routine endotracheal intubation
Contraindications
• Hypersensitivity to succinylcholine or any component of the formulation
• Acute phase of injury following major burns, multiple trauma (greater than 5 days after injury)
• Skeletal muscle myopathies
• DO NOT USE IN PATIENTS WITH BURNS, CRUSH INJURIES, OR HYPERKALEMIA
• Neuromuscular disease (muscular dystrophy, spinal muscular atrophy, etc.)
Adverse Reactions/Precautions
• May cause bradycardia, malignant hyperthermia, and increased intraocular pressure
• Severe hyperkalemia can develop in cases of chronic abdominal infection, burn injury,
children with skeletal muscle myopathy, subarachnoid hemorrhage, or conditions that cause
degeneration of the nervous system, commonly greater than 5 days old. A potassium increase of
0.5mEq/L is expected with use.
• Re-dosing is not advised due to increased risk of hyperkalemia
• Provides NO analgesia or sedation! Must provide appropriate sedation and analgesia
prior to paralytic use and throughout maintenance
• Pediatrics: risk of ventricular dysrhythmias, cardiac arrest, and death from hyperkalemic
rhabdomyolysis
• Pregnancy: Category C
• Lactation: Use caution
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Rapid Sequence Intubation/Neuromuscular Rapid Sequence Intubation/Neuromuscular
Blockade Blockade
• IV/IO • IV/IO
˚ 1.5mg/kg ˚ <5y/o: 2mg/kg/dose
Note: Pretreatment with 10% dosage of ˚ >5y/o: 1.5mg/kg/dose
nondepolarizing agents prior to neuromuscular Note: Pretreatment with 10% dosage of
blockade with Succinylcholine is NO LONGER nondepolarizing agents prior to neuromuscular
ADVISED blockade with Succinylcholine is NO LONGER
ADVISED

166 • MEDICATIONS