Succinylcholine

INTRODUCTION

Indications

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

Action

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.

Adverse Reactions/Side Effects

Most adverse reactions to succinylcholine are extensions of pharmacologic effects

Resp: APNEA, bronchospasm. CV: arrhythmias, bradycardia, hypotension. F and E: HYPERKALEMIA. MS: RHABDOMYOLYSIS, muscle fasciculation. Misc: MALIGNANT HYPERTHERMIA, myoglobinemia (↑ in children), myoglobinuria (↑ in children), tachyphylaxis.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess respiration, and notify physician or nursing staff immediately if patient exhibits any interruption in respiratory rate (apnea) or signs of respiratory failure (rapid labored breathing, cyanosis, confusion, irritability, sleepiness, headache, oxygen desaturation).

• Monitor symptoms of high plasma potassium levels (hyperkalemia), including bradycardia, fatigue, weakness, numbness, and tingling. Notify physician or nursing staff immediately because severe cases can lead to life-threatening arrhythmias and paralysis.

• Be alert for a rapid rise in body temperature, especially if accompanied by muscle rigidity and stiffness. These may be signs of malignant hyperthermia, and the physician or nursing staff should be notified immediately.

• Assess any muscle pain, tenderness, or weakness, especially if accompanied by fever, malaise, and dark-colored urine. These symptoms may indicate myopathy that can progress to severe muscle damage (rhabdomyolysis). Report any unexplained musculoskeletal symptoms to the physician or nursing staff immediately.

• Assess symptoms of bronchospasm (wheezing, coughing, tightness in chest) or decreased respiratory muscle function. Perform pulmonary function tests to quantify suspected changes in ventilation and respiration (See Appendix I).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms

• Be alert for a sudden increase in muscle contraction that might indicate a rapid decrease in drug effectiveness (tachyphylaxis).

Interventions

• Design and implement therapeutic exercises (resistive training, gait training) as needed to help resolve any residual weakness or myopathy caused by this drug. Begin exercises at low intensity and progress the exercise regimen slowly to avoid fatigue or excessive stress to damaged muscles.

Pharmacokinetics

Absorption: Well absorbed after deep IM administration.

Distribution: Widely distributed into extracellular fluid. Crosses the placenta in small amounts.

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