Parenteral Manual

Succinylcholine chloride

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
QUELICIN®
Classification: 
Neuromuscular blocking agent
Original Date: 
August 2005
Revised Date: 
September 2009
Indications: 
  • Adjunct to anaesthesia to induce skeletal muscle relaxation
  • Endotracheal intubation, endoscopy and short manipulative procedures                           
Reconstitution and Stability: 
  • Available as a 20 mg/mL injection
  • Refrigerate vials - unopened vials stable 6 months at room temperature      
  • Diluted solutions stable 24 hours in the fridge in D5W, NS and ringer's lactate
Compatibility: 

- Solutions Compatible: dextrose solutions up to D10W, saline solutions, dextrose-saline combinations, ringer's solution, ringer's lactate

- Additive/buretrol Compatible: no information

- Y-site Compatible: heparin, propofol, KCl (up to 40 mEq/L)

- Incompatible: alkaline solutions (e.g. thiopental, pentobarbital), sodium bicarbonate

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM YES, deep
IV Push

YES
Usual dilution: 20 mg/mL
Infusion time: 10-30 seconds
IV Intermittant Infusion NO
IV Continuous Infusion

YES; (in adults)
Usual dilution: 1-2 mg/mL

NOT recommended in infants and children
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

  • 2.5-4 mg/kg IM (Maximum: 150 mg/dose)
  • 1-2 mg/kg IV initially (Maximum: 150 mg/dose); then
  • Maintenance:  0.3-0.6 mg/kg IV every 5-10 minutes PRN

Adult:          

  • 0.6 mg/kg IV/IM (range:  0.3-1.1 mg/kg), up to 150 mg total dose
  • Maintenance: 0.04-0.07 mg/kg IV/IM Q 5-10 minutes PRN
  • Continuous IV infusion: 0.5-10 mg/minute
Potential hazards of parenteral administration: 
  • Paralysis of respiratory muscles causing apnea and hypoxia
  • Transient muscle fasciculations with too rapid administration
  • Transient cardiac arrhythmias, especially bradycardia in children
  • Malignant hyperthermia
  • Increased intraocular pressure                                                                    
  • Hyperkalemia
Notes: 
  • Monitor temperature, serum potassium, serum calcium, heart rate
  • Facilities for intubation, artificial respiration and oxygen must be available  
  • Caution in patients with electrolyte imbalance, decreased plasma pseudocholinesterase activity, severe liver disease or severe anemia or recovering from severe trauma
  • Contraindicated in malignant hyperthermia, narrow-angle glaucoma, severe sepsis, severe burns 
  • Anticholinesterases (eg. edrophonium, neostigmine)  do not reverse the effects but may prolong the effects
  • Onset of action:
    - IV: 1 minute
    - IM: 2-3 minutes
  • Duration:
    - IV: 4-6 minutes                                   
    - IM: 10-30 minutes 
References: 

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