Suxamethonium

Suxamethonium

[1 vial $1.90]

ADMINISTRATION ROUTES:

  • IV

ALTERNATIVE NAMES:

  • aka Succinyl Choline

ICU INDICATIONS:

  1. 1. Muscle Relaxant (for rapid sequence induction)

PRESENTATION AND ADMINISTRATION:

  • IV:
    Suxamethonium 100mg/2ml
    Administer neat Refrigerate.
    Stable at room temperature for 14 days.

DOSAGE:

  • IV:
    1mg/kg

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function; avoid if there is hyperkalaemia

DOSAGE IN PAEDIATRICS:

  • IV:
    Neonate: 3mg/kg
    Child: 2mg/kg
    Note: in children, there is a risk of bradycardia and asystole particularly if there is hypoxia. Suxamethonium should be given with atropine.

CLINICAL PHARMACOLOGY:

  • Suxamethonium is a depolarizing skeletal muscle relaxant.

CONTRAINDICATIONS:

  1. muscular dystrophy or other skeletal myopathies (including critical illness myopathy)
  2. personal or family history of malignant hyperthermia
  3. hypersensitivity to suxamethonium
  4. acute phase of injury following major burns, extensive denervation of skeletal muscle, or upper motor neuron injury
    [The risk of hyperkalemia in these patients increases over time and usually peaks at 7-10 days after the injury. The risk is dependent on the extent and location of the injury. The precise time of onset and the duration of the risk period are not known.]

WARNINGS

  • Cardiac arrest in children:
    There have been rare reports of acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest and death after the administration of suxamethonium to apparently healthy children who were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne’s muscular dystrophy. Therefore, when a healthy appearing infant or child develops cardiac arrest soon after administration of suxamethonium not felt to be due to inadequate ventilation, oxygenation or anaesthetic overdose, immediate treatment for hyperkalemia should be instituted.
    Electrolyte disturbances & digoxin toxicity
    :
    Suxamethonium should be administered with GREAT CAUTION to patients suffering from electrolyte abnormalities and those who may have massive digitalis toxicity, because in these circumstances suxamethonium may induce serious cardiac arrhythmias or cardiac arrest due to hyperkalemia.
  • Malignant Hyperthermia:
    Suxamethonium administration has been associated with acute onset of malignant hyperthermia, a potentially fatal hypermetabolic state of skeletal muscle.

PRECAUTIONS

  • General:
    Suxamethonium may cause raised intraocular pressure & raised intracranial pressure
  • Laboratory Tests: No tests additional to routine ICU tests are required
  • Drug/Laboratory Test Interactions: None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Drugs which may enhance the neuromuscular blocking action of suxamethonium include: gentamicin, lithium carbonate, magnesium salt and metoclopramide.
  • The neuromuscular blocking effect of suxamethonium may be enhanced by drugs that reduce plasma cholinesterase activity (e.g., chronically administered oral contraceptives, glucocorticoids, or certain monoamine oxidase inhibitors).

ADVERSE REACTIONS

  • General: Allergic reactions (anaphylactic or anaphylactoid responses), malignant hyperthermia
  • Musculoskeletal: Inadequate block, prolonged block.
  • Cardiovascular:Hypotension, hypertension, vasodilatation (flushing), tachycardia, bradycardia.
  • Respiratory: Respiratory arrest, dyspnoea, bronchospasm, laryngospasm.
  • Renal system: rhabdomyolysis with possible myoglobinuric acute renal failure

Critical Care Drug Manual

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