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succinylcholine
generic
Black Box Warnings .
Cardiac Arrest Risk (peds patients)
rare acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death after administration to apparently healthy children subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne muscular dystrophy; peaked T-waves, sudden cardiac arrest within minutes after administration; usually males <8 yo but also reported in adolescents; treat for hyperkalemia if cardiac arrest with no other cause develops soon after administration; reserve use in children for emergency intubation or need for immediate secure airway
Adult Dosing .
Dosage forms: INJ
neuromuscular blockade induction
- [0.3-1.1 mg/kg/dose IV x1]
- Max: 150 mg/total dose IM; Alt: 3-4 mg/kg/dose IM x1; Info: consider premed with atropine; onset 1min (IV), 2-3min (IM); duration 4-6min (IV), 10-30min (IM) (ultra short-acting)
neuromuscular blockade maintenance
- [0.04-0.07 mg/kg/dose IV q5-10min prn]
- Alt: 0.5-10 mg/min IV; Info: consider premed with atropine
rapid sequence intubation (off-label)
- [1-2 mg/kg/dose IV x1]
- Start: immediately after induction agent; Info: wait 60sec to perform laryngoscopy and intubate; see Rapid Sequence Intubation (RSI), Adult table
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ
neuromuscular blockade induction
- [1-2 mg/kg/dose IV x1]
- Alt: 2.5-4 mg/kg/dose IM x1; Info: consider premed with atropine; onset 1min (IV), 2-3min (IM); duration 4-6min (IV), 10-30min (IM) (ultra short-acting)
neuromuscular blockade maintenance
- [0.3-0.6 mg/kg/dose IV q5-10min prn]
- Info: consider premed with atropine
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [not defined]