Names and pronunciation
(suk-sin-ill-koe′leen) Anectine, Quelicin
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Drug reference
(suk-sin-ill-koe′leen) Anectine, Quelicin
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Func. class.: Neuromuscular blocker (depolarizing, ultra short)
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ACTION: Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, thus antagonizing action of acetylcholine; causes release of histamine
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USES: Facilitation of endotracheal intubation, skeletal muscle relaxation during orthopedic manipulations
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CONTRAINDICATIONS: Hyper- sensitivity, malignant hyperthermia, trauma Precautions: Pregnancy, breastfeeding, geriatric or debilitated patients, cardiac disease, severe burns, fractures (fascicu- lations may increase damage), electro- lyte imbalances, dehydration, neuromus- cular/respiratory/cardiac/renal/hepatic disease, collagen diseases, glaucoma, eye surgery, hyperkalemia
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Black Box Warning: Children <2 yr, myopathy, rhabdomyolysis Black Box Warning: Myopathy, rhabdo- myolysis: in pediatric patients (rare) • Assess temperature for malignant hy- perthermia, previous reactions to anes- thesia or paralytics • Reassurance if communication is dif- ficult during recovery from neuromuscu- lar blockade; postoperative stiffness is normal, soon subsides • Pregnancy/breastfeeding: use only if clearly needed; cautious use in breast- feeding, excretion unknown
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SIDE EFFECTS CV: Bradycardia, tachycardia; increased, decreased B/P; sinus arrest, dysrhyth- mias, edema EENT: Increased secretions, intraocular pressure HEMA: Myoglobulinemia INTEG: Rash, flushing, pruritus, urticaria MS: Weakness, muscle pain, fascicula- tions, prolonged relaxation, myalgia, rhabdomyolysis RESP: Prolonged apnea, bronchospasm, cyanosis, respiratory depression, wheez- ing, dyspnea SYST: Anaphylaxis, angioedema
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INTERACTIONS Increase: dysrhythmias: theophylline Increase: neuromuscular blockade—ami- noglycosides, β-blockers, cardiac glyco- sides, clindamycin, lincomycin, procain- amide, quiNIDine, local anesthetics, polymyxin antibiotics, lithium, opioids, thi- azides, enflurane, isoflurane, magnesium salts, oxytocin Drug/Herb • Blocks succinylcholine: melatonin
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DOSAGE AND ROUTES • Adult: IV 0.3-1.1 mg/kg, max 150 mg, maintenance 0.04-0.07 mg/kg q5-10min as needed; CONT IV INFUSION dilute to concentration of 1-2 mg/mL in D5W or NS 10-100 mcg/kg/min • Child: IV initially 1-2 mg/kg; CONT IV INFUSION not recommended
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Available forms: Inj 20, 50, 100 mg/mL; powder for inj 100, 500 mg/vial, 1 g/vial
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Administer: • Give IV or IM; only experienced cli- S nicians familiar with the use of neuro- muscular blocking drugs should ad- minister or supervise the use of this product • Visually inspect parenteral products for particulate matter and discoloration before use • Monitor heart rate and mechanical ventilator status during use • Store in refrigerator, powder at room temperature; close tightly IM route • Recommended for infants and other patients in whom a suitable vein is not accessible • Inject into a large muscle, preferably high into the deltoid muscle; aspirate before injection Rapid IV injection route • Owing to tachyphylaxis and pro- longed apnea, this method is not recom- mended for prolonged procedures; rapid IV injection of succinylcholine can result in profound bradycardia or asys- tole in pediatric patients; as with adults, the risk increases with repeated doses; pretreatment with atropine may be needed • No dilution of injection solution is necessary • Inject rapidly IV over 10-30 sec Continuous IV infusion route • Not recommended for infants and chil- dren owing to risk of malignant hyper- thermia • This route is preferred for long surgi- cal procedures • Dilute succinylcholine to a concentra- tion of 1-2 mg/mL with D5W, D5NS, NS, or 1/6 M sodium lactate injection; 1 g of the powder for injection or 20 mL of a 50-mg/mL solution may be added to 1 L or 500 mL of diluent to give solutions containing 1 or 2 mg/mL, respectively; alternatively, 500 mg of the powder for injection or 10 mL of a 50 mg/mL solu- tion may be added to 500 mL or 250 mL of diluent to give solutions containing 1 or 2 mg/mL, respectively • Infuse IV at a rate of 2.5 mg/min (range = 0.5-10 mg/min); adjust rate based on patient’s response and requirements Y-site compatibilities: Etomidate, hepa- rin, potassium chloride, propofol, vit B/C
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Assess: • Electrolyte imbalances (potassium, magnesium); may lead to increased ac- tion of product • VS (B/P, pulse, respirations, airway) until fully recovered; rate, depth, pattern of respirations, strength of hand grip • I&O ratio; check for urinary retention, frequency, hesitancy • Recovery: decreased paralysis of face, diaphragm, leg, arm, rest of body • Allergic reactions: rash, fever, respi- ratory distress, pruritus; product should be discontinued
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Evaluate: • Therapeutic response: paralysis of jaw, eyelid, head, neck, rest of body Teach patient/family • Reason for product, expected results
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CLINICAL CONSIDERATIONS
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PHARMACOKINETICS Hydrolyzed in blood, excreted in urine (active/inactive metabolites) IM: Onset 2-3 min, duration 10-30 min IV: Onset 1 min, peak 2-3 min, duration 6-10 min
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• Child: IV initially 1-2 mg/kg; CONT IV INFUSION not recommended
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