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EMR
EMT
AEMT
Paramedic
Extended
Succinylcholine (Anectine®)
Action
Onset
Depolarizing Neuromuscular Blocking Agent
1 minute
Indications
Rapid Sequence Induction after anesthesia is achieved.
Adult Dose
1mg/kg rapid IV Push
Pediatric Dose
Do Not Use
Contraindications
Hyperkalemia, allergy, history of malignant hyperthermia, crush injuries, glaucoma, penetrating eye injuries,
neuromuscular disease, spinal trauma, abdominal sepsis, CVA, Parkinson’s Disease, Lou Gehrig’s Disease
(ALS), presence of burns more than 24 hours old.
Side Effects and Adverse Reactions
Muscular fasciculation (disorganized muscular contractions), respiratory depression, muscle relaxation,
increased ICP, rhabdomyolysis, decrease in heart rate, hyperkalemia, dysrhythmias, excessive salivation, rash.
Precautions
A proper screening for potential hyperkalemia should be performed prior to succinylcholine administration.
Some considerations in potential hyperkalemic patients include tall, peaked T-waves on the ECG, paresthesia
and weakness, patients who receive hemodialysis, patients taking potassium supplements (KCl, Klor-Con),
patients on certain medications for blood pressure control or heart failure (digitalis, amlodipine, ACE
inhibitors). Use caution in patients with closed head injuries.
Considerations
Ensure a GCS of 3 prior to succinylcholine administration. Your patient should be asleep before you paralyze
them. Neuromuscular blocking agents induce paralysis; the patient’s senses are still intact, unless proper
anesthesia is achieved.
Succinylcholine (Anectine®)