From the Guidelines
Succinylcholine should be administered at a dose of 1-2 mg/kg IV for Rapid Sequence Intubation (RSI) in adult patients. This recommendation is based on the most recent guidelines from the European Society of Anaesthesiology and Intensive Care, which suggest using a fast-acting muscle relaxant such as succinylcholine 1–2 mg kg-1 or rocuronium 0.9 to 1.2 mg kg-1 for RSII 1. The use of succinylcholine for RSI is also supported by the Society of Critical Care Medicine clinical practice guidelines, which suggest administering either rocuronium or succinylcholine for RSI when there are no known contraindications to succinylcholine 1.
Key Considerations
- The dose of succinylcholine for RSI should be individualized based on the patient's weight and medical history.
- Prior to administering succinylcholine, a sedative agent should be given, such as etomidate, ketamine, or propofol.
- Pre-oxygenation for 3-5 minutes before medication administration is essential to minimize the risk of hypoxia during intubation.
- Succinylcholine should be avoided in patients with hyperkalemia, burns, crush injuries, or neuromuscular disorders due to the risk of dangerous potassium release.
Alternative Options
- Rocuronium can be used as an alternative to succinylcholine for RSI, at a dose of 0.9-1.2 mg/kg IV.
- The choice of neuromuscular blocking agent should be based on the patient's individual needs and medical history, as well as the availability of reversal agents such as sugammadex.
Important Safety Considerations
- The use of succinylcholine and other neuromuscular blocking agents requires careful monitoring of the patient's vital signs and respiratory status.
- The risk of aspiration and other complications during RSI should be minimized through the use of cricoid pressure and other safety measures.
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 dosage of succinylcholine for Rapid Sequence Intubation (RSI) in adult patients is 0.6 mg/kg given intravenously, with an optimum dose ranging from 0.3 to 1.1 mg/kg 2.
From the Research
Dosage of Succinylcholine for Rapid Sequence Intubation (RSI) in Adult Patients
- The optimal dose of succinylcholine for RSI in adult patients is a topic of ongoing debate, with various studies suggesting different dosages 3, 4, 5, 6, 7.
- A study published in 2021 compared the intubating conditions achieved with succinylcholine 1 mg/kg and rocuronium 0.6 mg/kg after magnesium pretreatment, and found that the rate of excellent intubating conditions was similar between the two groups 3.
- Another study published in 2003 found that a dose of 0.56 mg/kg succinylcholine was required to achieve acceptable intubating conditions in 95% of patients within 60 seconds 4.
- A 2019 study compared the efficacy of rocuronium and succinylcholine for RSI in out-of-hospital emergency situations, and found that succinylcholine 1 mg/kg resulted in a higher first-attempt intubation success rate compared to rocuronium 1.2 mg/kg 6.
- A retrospective comparative study published in 2011 found that a succinylcholine dose of 0.45 mg/kg provided optimal intubation conditions in ASA III & IV emergency non-prepared patients, with a 100% success rate for tracheal intubation 7.
Key Findings
- The effective dose (ED95) of succinylcholine is less than 0.3 mg/kg, and the traditionally used dose of 1 mg/kg represents 3.5 to 4 times the ED95 7.
- Increasing the succinylcholine dosage shortens the onset time, prolongs the duration of action, and prolongs the duration of abdominal fasciculation 7.
- Reducing the dose of succinylcholine allows for a more rapid return of spontaneous respiration and airway reflexes 4, 7.