Anectine
Anectine
[an-ek´tin]succinylcholine
(sux-sin-il-koe-leen) succinylcholine,Anectine
(trade name),Quelicin
(trade name)Classification
Therapeutic: neuromuscular blocking agents depolarizingIndications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (skeletal muscle paralysis)
| ROUTE | ONSET | PEAK | DURATION |
| IM | up to 3 min | unknown | 10–30 min |
| IV | 0.5–1 min | 1–2 min | 4–10 min |
Contraindications/Precautions
Adverse Reactions/Side Effects
Most adverse reactions to succinylcholine are extensions of pharmacologic effectsRespiratory
- apnea (life-threatening)
- bronchospasm
Cardiovascular
- arrhythmias
- bradycardia
- hypotension
Fluid and Electrolyte
- hyperkalemia (life-threatening)
Musculoskeletal
- rhabdomyolysis (life-threatening)
- muscle fasciculation
Miscellaneous
- anaphylaxis (life-threatening)
- malignant hyperthermia (life-threatening)
- myoglobinemia (↑ in children)
- myoglobinuria (↑ in children)
- tachyphylaxis
Interactions
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.Route/Dosage
IV route is preferred, but deep IM injection may be used in children and patients without vascular accessTest DoseAvailability
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)
Implementation
- 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.