From the Guidelines
Succinylcholine is the most common paralytic anesthesia agent used by anesthesiologists, due to its rapid onset and short duration of action, making it ideal for rapid sequence intubation and short procedures. This depolarizing neuromuscular blocking agent typically works within 30-60 seconds and lasts for approximately 5-10 minutes. The standard adult dose is 1-1.5 mg/kg IV, as recommended by recent guidelines 1. Succinylcholine works by binding to acetylcholine receptors at the neuromuscular junction, initially causing depolarization (and fasciculations) before preventing further muscle contraction.
Important considerations include its contraindications in patients with malignant hyperthermia susceptibility, hyperkalemia, certain neuromuscular disorders, and recent burns or trauma due to the risk of dangerous potassium release. Side effects can include myalgia, increased intraocular pressure, and bradycardia. For longer procedures, non-depolarizing agents like rocuronium (0.6-1.2 mg/kg) are often preferred as they provide longer duration of action without the side effect profile of succinylcholine. According to a recent study, rocuronium has been proposed as an alternative to succinylcholine, with a meta-analysis showing that suxamethonium provides excellent intubation conditions more frequently than rocuronium 1. However, the use of sugammadex to reverse rocuronium rapidly may have encouraged the use of rocuronium in some settings when a selective relaxant binding agent (SRBA) is available 1.
Some key points to consider when using succinylcholine include:
- Rapid onset of action, making it ideal for rapid sequence intubation
- Short duration of action, typically lasting 5-10 minutes
- Standard adult dose of 1-1.5 mg/kg IV
- Contraindications in patients with malignant hyperthermia susceptibility, hyperkalemia, and certain neuromuscular disorders
- Side effects, including myalgia, increased intraocular pressure, and bradycardia. Recent guidelines recommend the use of a fast-acting muscle relaxant such as succinylcholine 1–2 mg kg-1 or rocuronium 0.9 to 1.2 mg kg-1 for rapid sequence intubation 1.
From the Research
Paralytic Anesthesia Agents
- The most common paralytic anesthesia agent used by anesthesiologists is rocuronium 2, 3, 4.
- Rocuronium is a non-depolarizing muscle relaxant with a brief onset of action, making it a suitable alternative to succinylcholine for rapid-sequence induction of anesthesia 4.
- Studies have shown that rocuronium provides good intubating conditions and a high success rate of endotracheal intubation, especially when used in combination with sugammadex for reversal 2, 5.
- The optimal dose of rocuronium for rapid-sequence induction of anesthesia is typically between 0.9-1.2 mg/kg, which provides a similar onset time to succinylcholine but with a longer duration of action 4.
- Other paralytic agents, such as atracurium and vecuronium, can also be used for rapid-sequence induction of anesthesia, but may have different dosing requirements and efficacy profiles 6, 4.