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trademark for preparations of succinylcholine, a neuromuscular blocking agent.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


(sux-sin-il-koe-leen) ,


(trade name),


(trade name)


Therapeutic: neuromuscular blocking agents depolarizing
Pregnancy Category: C


Used during surgical procedures to produce skeletal muscle paralysis after induction of anesthesia and provision of opioid analgesics.


Prevents neuromuscular transmission by blocking the effect of acetylcholine at the myoneural junction.
Has agonist activity initially, producing fasciculation.
Causes the release of histamine.
Has no analgesic or anxiolytic effects.

Therapeutic effects

Skeletal muscle paralysis.


Absorption: Well absorbed after deep IM administration.
Distribution: Widely distributed into extracellular fluid. Crosses the placenta in small amounts.
Metabolism and Excretion: 90% metabolized by pseudocholinesterase in plasma. 10% excreted unchanged by the kidneys.
Half-life: Unknown.

Time/action profile (skeletal muscle paralysis)

IMup to 3 minunknown10–30 min
IV0.5–1 min1–2 min4–10 min


Contraindicated in: Hypersensitivity to succinylcholine or parabens; Plasma pseudocholinesterase deficiency; Pediatric: Children and neonates (continuous infusions); Personal history of malignant hyperthermia.
Use Cautiously in: History of anaphylaxis to other neuromuscular blockers; Familial history of malignant hyperthermia; History of pulmonary disease, renal or liver impairment; Major trauma, burns, or underlying myopathy (↑ risk of rhabdomyolysis and hyperkalemia, especially in children or adolescents); Glaucoma; Electrolyte disturbances; Receiving digoxin; Fractures or muscular spasm; Myasthenia gravis or myasthenic syndromes; Geriatric: Geriatric or debilitated patients; Obstetric: Has been used in pregnant women undergoing cesarean section; Pediatric: Children and neonates (↑ risk of malignant hyperthermia).

Adverse Reactions/Side Effects

Most adverse reactions to succinylcholine are extensions of pharmacologic effects


  • apnea (life-threatening)
  • bronchospasm


  • arrhythmias
  • bradycardia
  • hypotension

Fluid and Electrolyte

  • hyperkalemia (life-threatening)


  • rhabdomyolysis (life-threatening)
  • muscle fasciculation


  • anaphylaxis (life-threatening)
  • malignant hyperthermia (life-threatening)
  • myoglobinemia (↑ in children)
  • myoglobinuria (↑ in children)
  • tachyphylaxis


Drug-Drug interaction

Intensity and/or duration of paralysis may be prolonged by pretreatment with general anesthesia, aminoglycosides, polymyxin B, colistin, clindamycin, lidocaine, quinidine, procainamide, beta blockers, lithium, cyclophosphamide, phenelzine, potassium-losing diuretics, and magnesium salts.↑ risk of adverse cardiovascular reactions with opioid analgesics or digoxin.


IV route is preferred, but deep IM injection may be used in children and patients without vascular accessTest Dose
Intravenous (Adults) 5–10 mg (0.1 mg/kg), then assess respiratory function.
Short Procedures
Intravenous (Adults) 0.6 mg/kg (range 0.3–1.1 mg/kg) up to 150 mg total dose; additional doses depend on response, maintenance: 0.04–0.07 mg/kg q 5–10 min as needed.
Intravenous (Children) 1–2 mg/kg, up to 150 mg; additional doses depend on response, maintenance: 0.3–0.6 mg/kg q 5–10 min as needed, (continuous infusion not recommended in children or neonates because of the risk of malignant hyperthermia).
Prolonged Procedures
Intravenous (Adults) 2.5 mg/min infusion (range 0.5–10 mg/min).
Intramuscular Dosing
Intramuscular (Adults and Children) Up to 3—4 mg/kg (total dose not to exceed 150 mg).


Injection: 20 mg/mL, 100 mg/mL

Nursing implications

Nursing assessment

  • Assess respiratory status continuously throughout use of succinylcholine. Succinylcholine should be used only by individuals experienced in endotracheal intubation, and equipment for this procedure should be immediately available.
  • Monitor neuromuscular response to succinylcholine with a peripheral nerve stimulator intraoperatively. Paralysis is initially selective and usually occurs consecutively in the following muscles: levator muscles of eyelids, muscles of mastication, limb muscles, abdominal muscles, muscles of the glottis, intercostal muscles, and the diaphragm.
  • Monitor ECG, heart rate, and BP throughout use of succinylcholine.
  • Assess patient for history of malignant hyperthermia before administration. Monitor for signs of malignant hyperthermia (tachycardia, tachypnea, hypercarbia, jaw muscle spasm, lack of laryngeal relaxation, hyperthermia) throughout administration.
  • Observe patient for residual muscle weakness and respiratory distress during the recovery period.
  • Lab Test Considerations: May cause hyperkalemia, especially in patients with severe trauma, burns, or neurologic disorders.
  • If overdose occurs, use peripheral nerve stimulator to determine degree of neuromuscular blockade. Maintain airway patency and ventilation until recovery of normal respirations occurs.

Potential Nursing Diagnoses

Ineffective breathing pattern (Indications)
Impaired verbal communication (Side Effects)


  • high alert: Unplanned administration of a neuromuscular blocking agent instead of administration of the intended medication, or administration of a neuromuscular blocking agent in the absence of ventilatory support has resulted in serious harm and death. Watch for packaging similarities and double check for correct medication and dose.
  • Succinylcholine has no effect on consciousness or the pain threshold. Adequate anesthesia should always be used when succinylcholine is used as an adjunct to surgical procedures or when painful procedures are performed. To avoid patient distress, administer after unconsciousness has been achieved. Benzodiazepines and/or analgesics should be administered concurrently when prolonged succinylcholine therapy is used for ventilator patients because patient is awake and able to feel all sensations.
    • If eyes remain open throughout prolonged administration, protect corneas with artificial tears.
    • To prevent excessive salivation, patients may be premedicated with atropine or scopolamine.
    • A small dose of a nondepolarizing agent may be used before succinylcholine to decrease the severity of muscle fasciculations.
    • When used prior to electroconvulsive therapy, shock should be administered 1 min after administration.
  • Intramuscular: If IM route is used, administer deep into the deltoid muscle.
  • Intravenous Administration
  • Intravenous: A test dose of 5–10 mg or 0.1 mg/kg may be administered to determine patient’s sensitivity and recovery time.
  • Diluent: May be administered undiluted.
  • Rate: Usual adult dose is administered over 10–30 sec. Dose is titrated to patient response.
  • Continuous Infusion: Diluent: Dilute as a 0.1–0.2% solution (1–2 mg/mL) in dextrose/Ringer’s or lactated Ringer’s combinations, dextrose/saline combinations, 0.45% NaCl, 0.9% NaCl, D5W, D10W, Ringer’s or lactated Ringer’s injection. Solution is stable for 24 hr at room temperature. Administer only clear solutions. Discard any unused solution.
  • Rate: Administer at a rate of 0.5–10 mg/min; usual rate is 2.5–4.3 mg/min. Titrate dose to patient response and degree of paralysis required.
  • Y-Site Compatibility: acyclovir, alfentanil, alemtuzumab, amikacin, aminocaproic acid, aminiophylline, amphotericin B lipid complex, anidulafungin, argatroban, asorbic acid, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, caspofungin, cefazolin, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, cisplatin, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxycycline, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etomidate, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hetastarch, hydrocortisone, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methotrexate, methoxamine, methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, miconazole, midazolam, milrinone, minocycline, mitoxantrone, morphine, multivitamins, mycophenolate, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pantoprazole, papaverine, pemetrexed, pentamidine, pentazocine, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, sodium acetate, streptokinase, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, vancomycin, vasopressin, vecuronium, verapamil, vincristine, vinorelbine, vitamin B complex with C, voriconazole, zoledronic acid
  • Y-Site Incompatibility: amphotericin B colloidal, azathioprine, dantrolene, diazepam, diazoxide, ganciclovir, indomethacin, nafcillin, oxacillin, penicillin G, pentobarbital, phenobarbital, phenytoin, sodium bicarbonate, thiopental, trimethoprim/sulfamethoxazole

Patient/Family Teaching

  • Explain all procedures to patient receiving succinylcholine therapy without anesthesia, because consciousness is not affected by succinylcholine alone. Provide emotional support.
  • Reassure patient that communication abilities will return as the medication wears off.

Evaluation/Desired Outcomes

  • Adequate suppression of the twitch response when tested with peripheral nerve stimulation, with subsequent muscle paralysis.
Drug Guide, © 2015 Farlex and Partners


Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
References in periodicals archive ?
Till date, Suxamethonium chloride is the drug of choice for this purpose as it provides excellent intubating conditions within 60 seconds when given in a dose of 1-1.5 mg/kg.