succinylcholine

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

succinylcholine

Indication

  • Skeletal muscle relaxation during endotracheal intubation

Dosage Guidelines

  • IV 2 mg/kg/dose
  • Please consult the Neonatal Premedication for Endotracheal Intubation Standardized Dosing Chart for weight banded dosing on the NICU intranet site

Administration

  • IV direct over 10 to 30 seconds by MD/NP or under direct supervision of MD/NP
  • Flush with D5W or normal saline

Adverse Effects

  • Initial muscle twitching, transient apnea, histamine release
  • Bradycardia accompanied by hypotension, cardiac arrythmias (from vagal stimulation)
  • Jaw rigidity
  • Slight and transient increase in intraocular pressure
  • Increase in intragastric pressure secondary to fasciculation of abdominal muscles
  • Excessive salivation
  • Rash
  • Hyperkalemia (caused by the release of intracellular potassium into the plasma)

Comments

  • Onset: within 30 seconds
  • Duration: 4 to 8 minutes
  • Premedication with atropine may inhibit vagal stimulation and excessive salivation
  • Caution in infants with a family history of malignant hyperthermia
  • Caution in infants with electrolyte imbalance (especially hyperkalemia, hypocalcemia) and those with fractures or dislocations due to the initial muscle fasciculation
  • Prolonged respiratory depression in infants with liver disease (decreased breakdown of succinylcholine), malnutrition, concomitant aminoglycoside therapy, and hypothermia
  • Effects are not reversible with neostigmine

Supplied As

  • 20 mg/mL (20 mL vial) refrigerated
References
  1. LexiComp Sick Kids
  2. LexiComp Pediatric and Neonatal
  3. Neofax