From the Guidelines
Succinylcholine (Succs) typically lasts approximately 5 minutes, as indicated by the most recent and highest quality study 1. The duration of action of succinylcholine is due to its rapid metabolism by plasma pseudocholinesterase, which hydrolyzes about 90-95% of the drug before it can reach the neuromuscular junction. Some key points to consider about succinylcholine include:
- Onset of action is extremely rapid, usually within 30-60 seconds after IV administration, making it valuable for rapid sequence intubation 1.
- Certain factors can prolong its duration, including genetic variants of pseudocholinesterase, liver disease, pregnancy, certain medications, hypothermia, and electrolyte abnormalities.
- In patients with pseudocholinesterase deficiency, the duration can be dramatically extended from minutes to several hours, requiring continued ventilatory support until the drug effect wears off, as noted in 1. The most important consideration for healthcare providers is to be prepared for potentially prolonged paralysis when administering succinylcholine, especially in patients with unknown pseudocholinesterase status or risk factors for prolonged effect. Key considerations for the use of succinylcholine include:
- Standard intubating dose of 1-1.5 mg/kg
- Rapid sequence intubation
- Potential for prolonged paralysis in certain patients Overall, the duration of action of succinylcholine is approximately 5 minutes, but can be prolonged in certain patients, and healthcare providers should be prepared for this possibility.
From the FDA Drug Label
Onset of flaccid paralysis is rapid (less than one minute after intravenous administration), and with single administration lasts approximately 4 to 6 minutes. The duration of action of succinylcholine (Succs) is approximately 4 to 6 minutes after a single intravenous administration 2.
From the Research
Duration of Succinylcholine
- The duration of action of succinylcholine is approximately 10 minutes 3.
- A study published in 2003 found that the times to 90% twitch recovery at the adductor pollicis were 6.6 +/- 1.5 min, 7.6 +/- 1.6 min, and 9.3 +/- 1.2 min for doses of 0.40,0.60, and 1.0 mg/kg succinylcholine, respectively 4.
- Reducing the dose of succinylcholine from 1.0 mg/kg to 0.60 mg/kg shortens the duration of effect at the adductor pollicis by more than 90 s 4.
Comparison with Rocuronium
- Rocuronium has a significantly longer duration of action (∼30 min) compared to succinylcholine (∼10 min) 3.
- A study published in 2011 found that the duration of the intubation sequence was shorter after succinylcholine than after rocuronium (81 ± 38 sec versus 95 ± 48 sec; P = 0.002) 5.
- A meta-analysis published in 2008 found that succinylcholine created superior intubation conditions to rocuronium when comparing both excellent and clinically acceptable intubating conditions 6.
Clinical Implications
- The choice of succinylcholine or rocuronium for rapid sequence intubation may depend on various factors, including the patient's medical condition and the clinical setting 5, 7.
- A study published in 2016 found that succinylcholine was associated with increased mortality compared with rocuronium in severely brain-injured patients undergoing rapid sequence intubation in the emergency department 7.