Classifications: depolarizing skeletal muscle relaxant; Therapeutic: depolarizing skeletal muscle relaxant
Pregnancy Category: C
20 mg/mL, 50 mg/mL, 100 mg/mL injection
Synthetic, ultrashort-acting depolarizing neuromuscular blocking agent with high affinity for acetylcholine (ACh) receptor sites.
Initial transient contractions and fasciculations are followed by sustained flaccid skeletal muscle paralysis produced by state of accommodation that develops in adjacent excitable muscle membranes.
To produce skeletal muscle relaxation as adjunct to anesthesia; to facilitate intubation and endoscopy, to increase pulmonary compliance in assisted or controlled respiration, and to reduce intensity of muscle contractions in pharmacologically induced or electroshock convulsions.
Hypersensitivity to succinylcholine; family history of malignant hyperthermia; burns; trauma; pregnancy (category C).
During delivery by cesarean section; lactation; kidney, liver, pulmonary, metabolic, or cardiovascular disorders; myasthenia gravis; dehydration, electrolyte imbalance, patients taking digitalis, severe burns or trauma, fractures, spinal cord injuries, degenerative or dystrophic neuromuscular diseases, low plasma pseudocholinesterase levels (recessive genetic trait, but often associated with severe liver disease, severe anemia, dehydration, marked changes in body temperature, exposure to neurotoxic insecticides, certain drugs); collagen diseases, porphyria, intraocular surgery, glaucoma; lactation.
Route & Dosage
|Surgical and Anesthetic Procedures
Adult: IV 0.31.1 mg/kg administered over 1030 sec, may give additional doses prn IM 2.54 mg/kg up to 150 mg
Child: IV 12 mg/kg administered over 1030 sec, may give additional doses prn IM 2.54 mg/kg up to 150 mg
Prolonged Muscle Relaxation
Adult: IV 0.510 mg/min by continuous infusion
Dose based on IBW.
- Give IM injections deeply, preferably high into deltoid muscle.
PREPARE: Direct: Give undiluted. Intermittent/Continuous: Dilute 1 g in 5001000 mL of D5W or NS.
ADMINISTER: Direct: Give a bolus dose over 30 sec. Intermittent/Continuous: Preferred. Give at a rate of 0.510 mg/min. Do not exceed 10 mg/min.
INCOMPATIBILITIES Solution/additive: Aminophylline, ampicillin, cephalothin, diazepam, epinephrine, hydrocortisone, methicillin, methohexital, nitrofurantoin, oxacillin, oxytetracycline, sodium bicarbonate, thiopental, warfarin. Y-site: Thiopental.
- Note: Expiration date and storage before and after reconstitution; varies with the manufacturer.
Adverse Effects (≥1%)CNS: Muscle fasciculations, profound and prolonged muscle relaxation, muscle pain. CV: Bradycardia, tachycardia, hypotension, hypertension, arrhythmias, sinus arrest. Respiratory: Respiratory depression, bronchospasm, hypoxia, apnea. Body as a Whole: Malignant hyperthermia, increased IOP, excessive salivation, enlarged salivary glands. Metabolic: Myoglobinemia, hyperkalemia. GI: Decreased tone and motility of GI tract (large doses).
InteractionsDrug: Aminoglycosides, colistin, cyclophosphamide, cyclopropane, echothiophate iodide, halothane, lidocaine, magnesium salts, methotrimeprazine, narcotic analgesics, organophosphamide insecticides, mao inhibitors, phenothiazines, procaine, procainamide, quinidine, quinine, propranolol may prolong neuromuscular blockade; digitalis glycosides may increase risk of cardiac arrhythmias.
PharmacokineticsOnset: 0.51 min IV; 23 min IM. Duration: 23 min IV; 1030 min IM. Distribution: Crosses placenta in small amounts. Metabolism: In plasma by pseudocholinesterases. Elimination: In urine.
Assessment & Drug Effects
- Lab tests: Obtain baseline serum electrolytes. Electrolyte imbalance (particularly potassium, calcium, magnesium) can potentiate effects of neuromuscular blocking agents.
- Be aware that transient apnea usually occurs at time of maximal drug effect (12 min); spontaneous respiration should return in a few seconds or, at most, 3 or 4 min.
- Have immediately available: Facilities for emergency endotracheal intubation, artificial respiration, and assisted or controlled respiration with oxygen.
- Monitor vital signs and keep airway clear of secretions.
Patient & Family Education
- Patient may experience postprocedural muscle stiffness and pain (caused by initial fasciculations following injection) for as long as 2430 h.
- Be aware that hoarseness and sore throat are common even when pharyngeal airway has not been used.
- Report residual muscle weakness to physician.