Succinylcholine Dosage

Usual Adult Dose for Anesthesia

NOTE: The dose is dependent on body weight, the degree of muscular relaxation required, the route of administration, and the response of the individual patient.

A 5- to 10-mg test dose may be used to determine sensitivity of the patient and the individual recovery time.

Short Surgical Procedures:
0.3 to 1.1 mg/kg IV (average 0.6 mg/kg IV)
Comments:

• Neuromuscular blockade develops in about 1 minute.
• Maximum blockade may persist for about 2 minutes after which recovery takes place within 4 to 6 minutes; however, very large doses may result in more prolonged blockade.

Long Surgical Procedures:
2.5 to 4.3 mg IV per minute (NOTE: The dose depends on the duration of the surgical procedure and the need for muscle relaxation)
Comments:

• The 1 mg/mL formulation may be administered at a rate of 0.5 mg (0.5 mL) to 10 mg (10 mL) per minute to obtain the required amount of relaxation. The amount required depends on the individual response and the degree of relaxation required.
• Do not overburden circulation with a large volume of fluid.
• Monitor neuromuscular function with a peripheral nerve stimulator to avoid overdose, detect development of Phase II block, follow rate of recovery, and assess the effects of reversing agents.
• Intermittent IV injections of this drug may be used to provide muscle relaxation for long procedures. An IV injection of 0.3 to 1.1 mg/kg may be given initially, followed by further injections of 0.04 to 0.07 mg/kg to maintain the required degree of relaxation.

IM Administration: NOTE: This drug may be given IM when a vein is inaccessible.
3 to 4 mg/kg IM but not more than 150 mg total; the onset of effect is 2 to 3 minutes

Use: As an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation

Usual Pediatric Dose for Anesthesia

NOTE: The dose is dependent on body weight, the degree of muscular relaxation required, the route of administration, and the response of the individual patient.

A 5- to 10-mg IV test dose may be used to determine sensitivity of the patient and the individual recovery time.

Short Surgical Procedures:
0.3 to 1.1 mg/kg IV (average 0.6 mg/kg IV) over 10 to 30 seconds
Comments:

• Neuromuscular blockade develops in about 1 minute.
• Maximum blockade may persist for about 2 minutes after which recovery takes place within 4 to 6 minutes; however, very large doses may result in more prolonged blockade.

Long Surgical Procedures:
2.5 to 4.3 mg IV per minute (NOTE: The dose depends on the duration of the surgical procedure and the need for muscle relaxation)
Comments:

• The 1 mg/mL formulation may be administered at a rate of 0.5 mg (0.5 mL) to 10 mg (10 mL) per minute to obtain the required amount of relaxation. The amount required depends on the individual response and the degree of relaxation required.
• Do not overburden circulation with a large volume of fluid.
• Monitor neuromuscular function with a peripheral nerve stimulator to avoid overdose, detect development of Phase II block, follow rate of recovery, and assess the effects of reversing agents.
• Intermittent IV injections of this drug may be used to provide muscle relaxation for long procedures. An IV injection of 0.3 to 1.1 mg/kg may be given initially, followed by further injections of 0.04 to 0.07 mg/kg to maintain the required degree of relaxation.

IM Administration: NOTE: This drug may be given IM when a vein is inaccessible.
3 to 4 mg/kg IM but not more than 150 mg total; the onset of effect is 2 to 3 minutes

Use: As an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

US BOXED WARNINGS:
RISK OF CARDIAC ARREST FROM HYPERKALEMIC RHABDOMYOLYSIS:

• There have been rare reports of acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death after the administration of this drug healthy children who were found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne's muscular dystrophy. This syndrome presents as peaked T-waves and sudden cardiac arrest within minutes after administration (usually, but not exclusively, males, and most frequently 8 years of age or younger). There have also been reports in adolescents.
• When a healthy appearing infant or child develops cardiac arrest soon after administration of this drug not thought to be due to inadequate ventilation, oxygenation, or anesthetic overdose, immediate treatment for hyperkalemia should be instituted. This should include administration of IV calcium, bicarbonate, and glucose with insulin, with hyperventilation. Due to the abrupt onset of this syndrome, routine resuscitative measures may not be successful. However, extraordinary and prolonged resuscitative efforts have resulted in successful resuscitation in some cases. In addition, in the presence of signs of malignant hyperthermia, appropriate treatment should be instituted concurrently.
• Since there may be no signs to alert the practitioner to which patients are at risk, it is recommended that the use of this drug in children be reserved for emergency intubation or instances where immediate securing of the airway is necessary (e.g., laryngospasm, difficult airway, full stomach) or for IM use when a suitable vein is inaccessible.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

IV compatibility:

• This drug is acidic (pH 3.5) and should not be mixed with alkaline solutions having a pH greater than 8.5 (e.g., barbiturate solutions).

General:

• Admixtures should be used within 24 hours after preparation.
• Aseptic techniques should be used to prepare the diluted product.
• Admixtures should be prepared for single patient use only.
• The unused portion of diluted product should be discarded.

See also:

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer