Neonatal Drug Therapy Manual

Succinylcholine

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Updated February 21, 2024 - 12:45pm

Alternate Name(s): 
Anectin, Quelicin
Classification: 
Skeletal Muscle Relaxant
Original Date: 
June 1996
Revised Date: 
Feb 2024
Indications: 
  • For endotracheal intubation
Administration: 
  • IV Direct over 10-30 seconds
  • IM only if no intravenous access
Dosage: 
  • 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)
Side Effects: 
  • 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
Parameters to Monitor: 
  • BP, HR
  • Ventilation, oxygen saturation
Reconstitution and Stability: 
  • Unopened vials are stable for 6 months at room temperature without significant loss of potency
Compatibility: 

- Solutions Compatible: dextrose up to D10W, saline solutions, dextrose-saline solutions

Incompatible: alkaline solution, sodium bicarbonate

Notes: 
  • 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

References: 
  • 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. 

  • Allen KA. Premedication for neonatal intubation: which medications are recommended and why. Adv Neonatal Care. 2012 Apr;12(2):107-11.

  • https://www.dir.iwk.nshealth.ca/NeonatalResuscitation , accessed Feb 2024

  • Intubation for neonates: Neonatal ehandbook - Department of Health and Human Services, Victoria, Australia. Accessed online Feb 2024

  • NHSGGC Paediatrics for Health Professionals. Accessed Feb 2024

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