Suxamethonium
Suxamethonium is a depolarising neuromuscular blocker producing a rapid (1-2 minutes), complete and predictable relaxation of skeletal muscle. Its effect normally lasts 3-5 minutes. It is used for emergency intubation - passage of endotracheal tube.
It has many side-effects or rare complications:
- arrhythmias
- bradycardia:
- especially in children after repeated use
- requires a dose of atropine before administration of a second injection in the same patient
- hyperkalaemia:
- 0.5-1.0 mmol/l rise in plasma potassium
- dangerous rises reported in certain cases, e.g. burns, rhabdomyolysis
- increased intraocular pressure
- increased salivation
- myotonia
- painful fasciculation on injection - give after start of induction
- anaphylaxis
- malignant hyperthermia
- rarely, atypical pseudocholinesterase enzyme results in slow breakdown of suxamethonium; blockade may last for hours
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