From the FDA Drug Label
The average dose required to produce neuromuscular blockade and to facilitate tracheal intubation is 0.6 mg/kg Succinylcholine Chloride Injection given intravenously. The optimum dose will vary among individuals and may be from 0.3 to 1.1 mg/kg for adults.
The reintubation dose of succinylcholine is not explicitly stated in the drug label. However, based on the information provided for tracheal intubation, the dose for reintubation may be similar, ranging from 0.3 to 1.1 mg/kg for adults, but this is not directly stated in the label 1.
From the Research
The recommended dose of succinylcholine for reintubation is 0.6 mg/kg IV, as it provides excellent intubating conditions while allowing for a more rapid return of spontaneous respiration and airway reflexes 2. This dose is supported by a study published in Anesthesia and Analgesia, which found that 0.6 mg/kg of succinylcholine produces clinical intubation conditions identical to the traditional 1.0-mg/kg dose but is associated with a shorter recovery time 2.
Key Considerations
- When administering succinylcholine for reintubation, pretreatment with atropine (0.4-0.6 mg IV) should be considered to prevent bradycardia, especially in children or after a second dose.
- Be aware of contraindications including hyperkalemia, malignant hyperthermia susceptibility, neuromuscular disorders, and burns or crush injuries beyond 48 hours.
- Succinylcholine causes fasciculations and can increase intracranial, intraocular, and intragastric pressures.
- If reintubation is anticipated to be difficult, consider having alternative airway equipment ready and possibly using a non-depolarizing neuromuscular blocker like rocuronium (1.0 mg/kg) if succinylcholine is contraindicated.
Evidence Summary
- A study published in Anesthesiology found that reducing the dose of succinylcholine from 1.0 mg/kg to 0.6 mg/kg shortens the duration of effect at the adductor pollicis by more than 90 s 3.
- Another study published in Anesthesia and Analgesia found that the calculated dose of succinylcholine required to achieve excellent intubating conditions in 50% and 80% of patients at 60 s is 0.39 (0.29-0.51) mg/kg and 1.6 (1.2-2.0) mg/kg, respectively 4.
- A retrospective comparative study published in The Libyan Journal of Medicine found that a succinylcholine dose of 0.45 mg/kg provides an optimal intubation condition in ASA III & IV emergency non-prepared patients 5.