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succinylcholine
generic
Black Box Warnings .
Cardiac Arrest Risk (peds pts)
rare acute rhabdomyolysis w/ hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death after admin. to apparently healthy children subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne muscular dystrophy; peaked T-waves, sudden cardiac arrest w/in minutes after admin; usually males <8 yo but also reported in adolescents; treat for hyperkalemia if cardiac arrest w/ no other cause develops soon after admin; 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 w/ 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 w/ 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 w/ 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 w/ 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]