Succinylcholine is a skeletal muscle relaxant for intravenous (IV) administration indicated as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
✖ CAUTIONS: usually increases serum K+ by 0.5 mEq/L (on rare occasion causes severe hyperkalemia ([K+] up to 12 mEq/L) in patients with neuronal or muscular pathology, causing cardiac complications which cannot be blocked), therefore contraindicated in the acute phase of injury following major burns, multiple trauma or extensive denervation of skeletal muscle or upper motor neuron injury. Do not use for routine intubations in adolescents and children (may cause cardiac arrest even in apparently healthy youngsters, many of whom have undiagnosed myopathies). Linked to malignant hyperthermia
May cause dysrhythmias, especially sinus bradycardia (treat with atropine). May get autonomic stimulation from ACh-like action → HTN, and bradycardia - or tachycardia (especially in peds with repeated doses). The fasciculations may increase ICP, intragastric pressure, and intraocular pressure (contraindicated in penetrating eye injury, especially to the anterior chamber; OK in glaucoma). Precurarization with a “priming dose” of a nondepolarizing blocker (usually ≈ 10% of the intubating dose, e.g. pancuronium 0.5–1 mg IV 3–5 minutes prior to succinylcholine) in patients with elevated ICP or increased intraocular pressure (to ameliorate further pressure increases during fasciculation phase) and in patients who have eaten recently (controversial6). Phase II block (similar to nondepolarizing blocker) may develop with excessive doses or in patients with abnormal pseudocholinesterase.