Succinylcholine is used in anesthesia in order to facilitate endotracheal intubation, mechanical ventilation and a wide range of surgical and obstetric maneuvers. It can also be used to reduce the intensity of the muscle contractions during anticonvulsant therapy.
What is Succinylcholine?
Succinylcholine is a neuromuscular blocking agent (muscle relaxant) that belongs to and is the founder of the group of "depolarizing muscle relaxants". The compounds block the depolarizing neuromuscular transmission producing a partial depolarization of motor plaques of skeletal muscles, which makes the tissues unable to respond to the neurotransmitter acetylcholine. Generally, its effect lasts less than that of non-depolarizing neuromuscular blocking agents (tubocurarine, atracurium, cisatracurium, pipecuronium, vancuronium, etc.) and therefore they are used in smaller operations and interventions. In addition to Succinylcholine, decamethonium is also part of this group of medications.
How should Succinylcholine be taken?
Succinylcholine is available in the form of solution for injections that are performed intravenously.
Side effects associated with Succinylcholine
There are several side effects that can result from the use of this drug, including:
- Cardiovascular disorders: bradycardia, cardiac arrest, cardiac arrhythmias, tachycardia, hypotension, and hypertension;
- Endocrine and metabolic disorders: hyperkalemia, porphyria;
- Gastrointestinal disorders: excessive salivation;
- Haematological disorders: myoglobinaemia;
- Immunological disorders: anaphylactoid reactions;
- Musculoskeletal disorders: myalgia, myasthenia gravis, increased muscle rigidity, and rhabdomyolysis;
- Changes in renal function: renal impairment;
- Changes in respiratory function: respiratory paralysis, apnea, bronchospasm, pulmonary edema
Contraindications and warnings associated with the use of Succinylcholine
Particular care should be taken when administering this drug to patients with known or suspected hypersensitivity to the product or who have shown hypersensitivity to other neuromuscular blocking agents. Moreover, this drug should only be administered by experienced staff.
Similar to all other neuromuscular blocking agents, the dosage of succinylcholine should be individualized for each patient depending on age, body weight, the desired degree of muscle relaxation and individual response of the patient.
However, the administration of succinylcholine is contraindicated in the following cases: hypersensitivity to the drug; malignant hyperthermia; hyperkalemia and associated conditions; risk or presence of elevated intraocular pressure (glaucoma risk); congenital myotonic disorders; musculoskeletal myopathies; hereditary deficiency of plasma cholinesterase.
Particular attention should be paid in the administration of Succinylcholine in children, since pediatric patients are more likely to suffer from some pathological conditions, even undiagnosed, which puts them at increased risk of serious adverse events.
In cases of pregnancy, childbirth, the presence of tetanus, burns, severe or chronic infections, debilitating chronic diseases, malignant neoplasms, chronic anemia and malnutrition; autoimmune diseases, and severe dehydration – can increase the neuromuscular blocking effects. Although it has been shown that Succinylcholine does not cross the placental barrier, its administration to pregnant women is not recommended unless the potential benefit for maternal health outweighs any dangers for the unborn child.
