Succinylcholine

Contraindications

1) Known hyperK (current)

2) Massive burns >10% BSA (>4dys-healed)

3) Massive crush injuries (>4dys-healed)

4) Denervation* (>4dys-6mo)

5) Neuromuscular dz** (indefinite)

6) Intra-abdominal sepsis (>5dys-resolution)

7) Increased ICP (may use w/ defacic dose)

(From-To)

• CVA (in particular those with residual deficits), spinal cord injury

• • ALS, MS, skeletal muscle myopathies, cholinesterase def, h/o malignant hyperthermia

-no evidence to support contraindication in penetrating eye injuries-

N.B. Myasthenia Gravis- theoretically need more succ to induce vs nondepolarizing agents which have a prolonged effect.

This is 2/2 to lack of post-synaptic receptors, i.e. succ cannot potentiate a reaction 2/2 too few receptors.

Vs. it takes few "molecules" of roc/vec to block the few remaining functioning receptors.

Overall, most practitioners tend to avoid succ in all patients with possible neuromuscular disease.

Source

2/06 DONALDSON (Adapted from Rosen)

Levitan, R. Annals of EM. Vol 45, Issue 2. Safety of succinylcholine in myasthenia gravis.