Succinylcholine
RSI paralytic (depolarizing)
Indications
- RSI paralytic (depolarizing)
Adult dosing
- rsi: dose: 1.5; unit: mg/kg; route: IV; weightBased: true; maxDose: 200; maxDoseAbsolute: true
Pediatric dosing
- rsi: dose: 2; unit: mg/kg; route: IV; weightBased: true; maxDose: 150; maxDoseAbsolute: true; pedNote: Children <10kg may need up to 3mg/kg
Contraindications
- Hyperkalemia or risk of hyperkalemia (burns >24h, crush injury >72h, rhabdomyolysis, denervation injuries)
- Personal/family history of malignant hyperthermia
- Pseudocholinesterase deficiency
- Penetrating eye injury (relative)
Clinical pearls
- Fastest onset/offset of any paralytic — ideal when difficult airway anticipated
- Avoid in known or suspected hyperkalemia — can cause fatal cardiac arrest
- Baseline K+ >5.5 mEq/L — use rocuronium instead
Source and review
- Tintinalli's Emergency Medicine, 9th ed.. Last reviewed: 2024-10-15