- For endotracheal intubation
- IV Direct over 10-30 seconds
- IM only if no intravenous access
- IV: 1 - 2 mg/kg (0.05 - 0.1 mL/kg) then 0.3 - 0.6 mg/kg/dose Q5-10min PRN
- IM: 4 mg/kg/dose (0.2 mL/kg)
- CVS: bradycardia, hypotension
-
GI: excessive salivation
- Respiratory: respiratory muscle paralysis, risk of pulmonary aspiration because of lack of airway protection
- Potentially severe hyperkalemia may develop in patients with chronic abdominal infections, burn injuries, multiple trauma/crush injuries, extensive denervation of skeletal muscle, upper motor neuron injury, subarachnoid hemorrhage, certain muscular dystrophies, or conditions which cause degeneration of the central and peripheral nervous system
- BP, HR
- Ventilation, oxygen saturation
- Unopened vials are stable for 6 months at room temperature without significant loss of potency
- Solutions Compatible: dextrose up to D10W, saline solutions, dextrose-saline solutions
Incompatible: alkaline solution, sodium bicarbonate
- Muscle relaxation effects last about 2 - 4 minutes
- Effects are not reversible with neostigmine or endrophonium
-
Caution in patients with electrolyte imbalance, severe liver disease or severe anemia or recovering from severe trauma
-
Contraindicated in malignant hyperthermia, severe sepsis, severe burns
-
Rare reports of acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death have been reported in children with undiagnosed skeletal muscle myopathy, most frequently Duchenne muscular dystrophy
- Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 9th-11th Editions. Hudson: Lexi-Comp Inc.; 2002-2004.
- Lexi-Comp online Database, accessed Nov 2022.
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Allen KA. Premedication for neonatal intubation: which medications are recommended and why. Adv Neonatal Care. 2012 Apr;12(2):107-11.
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https://www.dir.iwk.nshealth.ca/NeonatalResuscitation , accessed Feb 2024
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Intubation for neonates: Neonatal ehandbook - Department of Health and Human Services, Victoria, Australia. Accessed online Feb 2024
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NHSGGC Paediatrics for Health Professionals. Accessed Feb 2024