Suxamethonium
From Ganfyd
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Rapid onset, short-acting 'depolarising' muscle relaxant.
Contents |
Clinical Use
Indications
Suxamethonium rapidly produces a brief profound muscular paralysis. It is used for intubation in emergency, and is the preferred relaxant if there is doubt about the ability to intubate or ventilate the patient, as it wears off in almost everyone before they would die of anoxia provided their lungs were initially in equilibrium with pure oxygen rather than air.
Administration
Clinical Issues
Toxicity
Contra-indications
Cautions and Interactions
An autosomal recessive gene results in low plasma cholinesterase activity in a small proportion of people. In these cases, suxamethonium's activity is prolonged, lasting hours rather minutes and can cause suxamethonium apnoea ("Scoline apnoea"). If there is a family history of this, blood can be sent to test for plasma cholinesterase activity as well as phenotyping of the genetic variant. As many as 30 polymorphisms are recognised, some of which increase susceptibility to apnoea, with considerable differences in between ethnic groups. [1] [2] [3] [4]
Side effects
- Muscular pain is common and can be severe
- Transient hyperkalaemia (therefore caution in burns & rhabdomyolysis)
- Histamine release
- Fasiculations
- Malignant hyperthermia
Special advice
Pharmacology
References
- ↑ Pinto Pereira LM, Clement Y, Telang BV, McFarlane H. Existence of a silent gene for pseudocholinesterase in a Trinidad population. West Indian Med J. 1994 Dec;43(4):140-2.
- ↑ Hosseini J, Firuzian F, Feely J. Ethnic differences in the frequency distribution of serum cholinesterase activity. Ir J Med Sci. 1997 Jan-Mar;166(1):10-2.
- ↑ Lando G, Mosca A, Bonora R, Azzario F, Penco S, Marocchi A, Panteghini M, Patrosso MC. Frequency of butyrylcholinesterase gene mutations in individuals with abnormal inhibition numbers: an Italian-population study. Pharmacogenetics. 2003 May;13(5):265-70.
- ↑ Vahdati-Mashhadian N, Hassanzadeh MK, Hosseini J, Saffareshargh AA. Ethnic differences in the frequency of distribution of serum cholinesterase activity in the Iranian population. Can J Physiol Pharmacol. 2004 May;82(5):326-30.
