Succinylcholine

Dose 1-1.5mg/kg
- higher in children who have more extracellular space
- use real weight (pseudocholinesterase increase with real weight)
- very weakly lipophilic

Duration 5-10 mins, Onset 30-60 secs

Metabolism by pseudocholinesterases
- dibucaine 80% normal, 20% homologous abnormal, 40-60% hetero; prolonged to 2-4 hours in homo, 20 min in hetero
- Medications that decrease pseduocholinesterases: phenelzine, neo, physo, edrothiophate, cyclophosphamide, metoclopromide, esmolol, OCPs
- metabolized to succinylmonocholine, which may sensitize SA node to 2nd dose of sux, causing brady

Interactions
- nondepolarizing blockers antagonize sux but prolongs phase II block
- cholinesterase blockers like neo, physo, organophosphate, echothiophate prolongs sux

CV
- brady and even asystole in children 2/2 muscarinic effects
- metabolized to succinylmonocholine, which may sensitize SA node to 2nd dose of sux, causing brady

Fasiculations and Mylagias
- possibly decreased by priming with non-depolarizing, but requires higher dose of sux 2/2 interactions

Hyperkalemia
- worst in day 7-10 after burn or trauma, minimal in 48 hours
- burns and traumas
- myopathies and GBS
- parkinsons, stroke, encephalitis, immobilization