What is the reintubation dose of succinylcholine (Succinylcholine)

From the Guidelines

The recommended reintubation dose of succinylcholine is 1.5 mg/kg IV for adults, as stated in the most recent and highest quality study 1. This dose provides adequate muscle relaxation for successful reintubation in emergency situations. When administering succinylcholine for reintubation, be prepared for potential side effects including hyperkalemia, malignant hyperthermia, increased intracranial pressure, and bradycardia. Pretreatment with atropine (0.4-0.6 mg IV) may be considered to prevent bradycardia, especially in children or after a second dose. Ensure the patient is adequately preoxygenated before administration, and have alternative airway equipment readily available. Succinylcholine is contraindicated in patients with personal or family history of malignant hyperthermia, hyperkalemia, neuromuscular disorders, and after major burns or trauma beyond 48-72 hours.

Some key points to consider when using succinylcholine for reintubation include:

• Rapid onset of action (within 30-60 seconds) due to depolarization of the neuromuscular junction
• Potential for residual effects if administered within 10-15 minutes of previous dose
• Importance of adequate preoxygenation and alternative airway equipment availability
• Contraindications and precautions for use, as mentioned earlier

It's also worth noting that other studies, such as 1 and 1, provide additional information on the use of succinylcholine and alternative muscle relaxants, such as rocuronium, in emergency intubation situations. However, the most recent and highest quality study 1 provides the recommended dose of 1.5 mg/kg IV for adults. In clinical practice, it's essential to weigh the benefits and risks of succinylcholine use and consider alternative options when necessary, always prioritizing patient safety and well-being.

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 2.

From the Research

Reintubation Dose of Succinylcholine

• The optimal dose of succinylcholine for reintubation is a topic of ongoing research, with various studies suggesting different doses 3, 4, 5, 6, 7.
• A study published in 2004 found that a dose of 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 3.
• Another study published in 2003 found that a dose of 0.56 mg/kg of succinylcholine is required to achieve acceptable intubating conditions in 95% of patients at 60 s 4.
• A retrospective comparative study published in 2011 found that a dose of 0.45 mg/kg of succinylcholine provides an optimal intubation condition in ASA III & IV emergency non-prepared patients 6.
• A prospective, randomized, double-blind, placebo-controlled study published in 2006 found that the calculated doses of succinylcholine required to achieve excellent intubating conditions in 50% and 80% of patients at 60 s are 0.39 mg/kg and 1.6 mg/kg, respectively 7.

Comparison of Different Doses

• A study published in 2005 compared the intubating conditions after rocuronium or succinylcholine for rapid sequence induction with alfentanil and propofol in emergency patients, and found that both rocuronium 0.6 mg/kg and succinylcholine 1.0 mg/kg provide clinically acceptable intubation conditions in 60 s 5.
• The same study found that the incidence of acceptable intubating conditions was not different among the different succinylcholine dose groups, suggesting that lower doses of succinylcholine may be effective for reintubation 5.

Factors Affecting Reintubation Dose

• The dose of succinylcholine required for reintubation may depend on various factors, including the patient's physical status, the type of surgery, and the anesthetic regimen used 3, 4, 5, 6, 7.
• The onset time, duration of action, and duration of abdominal fasciculation may also be affected by the dose of succinylcholine used 6.