Suxamethonium
 
Presentation
• 100mg in 2ml amp
Pharmacology
• Depolarising neuromuscular blocking agent
Actions
• Short acting muscular relaxant
Metabolism
• Pseudo-cholinesterase in plasma
Primary Emergency Indications
• Complete muscle relaxation to allow endotracheal intubation Adult
Contraindications
• Known hypersensitivity
• Upper airway obstruction
• Severe respiratory distress
• Penetrating eye injury
• ECG signs of hyperkalaemia in conditions such as muscle necrosis and renal failure
• Burns >24hrs post injury
• Organophosphate poisoning
• Ruptured Abdominal Aortic Aneurysm
• Known history of Suxamethonium apnoea
• Known history of malignant hyperthermia
Precautions
• Liver disease
• Elderly Pts
• Crush injuries
• Pts who have not fasted
• Airway trauma
Route of Administration
• IV
Side Effects
• Muscular fasciculation
• Increase in intraocular pressure
• Increase in intragastric pressure
• Elevated serum potassium levels
Special Notes
• Sedation is required prior to use
Atropine (600mcg) should be administered prior to Suxamethonium administration in adult Pts with a HR <60
Atropine 20mcg/kg should be administered prior to Suxamethonium administration in children
   - (Qualified MICA Flight Paramedics only)
• A second dose of Suxamethonium usually causes profound bradycardia
• Refrigeration of Suxamethonium is required
  - requires weekly rotation or disposal when not refrigerated
• Usual dosage:
  - Adults: 1.5mg/kg IV
  - Children: 1–2mg/kg IV (Qualified MICA Flight Paramedics only)
Therapeutic Effect
IV     
Onset:
20-40sec
Peak:
60sec
Duration:
4-6min