Succinylcholine contraindications

Succinylcholine 1-1.5 mg/kg IV up to 150 mg total dose ° Contraindications may include use in patients with a personal or family history of malignant hyperthermia, extensive/severe burns, myopathies with elevated creatine phosphokinase, penetrating eye injuries, pre-existing hyperkalemia, narrow-angle glaucoma, and disorders of plasma pseudocholinesterase... 

Use of the muscle relaxant succinylcholine, which is metabolized by plasma cholinesterase, is contraindicated in cases of organophosphate poisoning (Giurini et al. 1986). 

Drug interactions Co-administration of dinoprostone in patients receiving intravenous oxytocic agents such as oxytocin may result in uterine hyperstimulation and is therefore contraindicated. Severe hypertension has been reported when oxytocin was given 3 to 4 hours following prophylactic administration of a vasoconstrictor in conjunction with spinal anesthesia. Oxytocin may enhance the neuromuscular blockade of succinylcholine. 

Administration of succinylcholine may be associated with the rapid onset of an increase in intraocular pressure (< 60 seconds), peaking at 2-4 minutes, and declining after 5 minutes. The mechanism may involve tonic contraction of myofibrils or transient dilation of ocular choroidal blood vessels. Despite the increase in intraocular pressure, the use of succinylcholine for ophthalmologic operations is not contraindicated unless the anterior chamber is open ("open globe") due to trauma. 

Patients with burns, nerve damage or neuromuscular disease, closed head injury, and other trauma can respond to succinylcholine by an exaggerated release of potassium into the blood, occasionally resulting in cardiac arrest. As a result of the cardiac arrests (presumably caused by hyperkalemia), the Food and Drug Administration recommended in 1993 that succinylcholine no longer be used in children. However, this highly controversial contraindication was subsequently modified to a simple warning because no acceptable alternative to succinylcholine was available for rapid-sequence inductions. 

Rao TL, Shanmugam M. Succinylcholine administration — another contraindication Anesth Analg 1979 58(l) 61-2. 

Succinylcholine is contraindicated in patients with genetic disorders of plasma pseudocholinesterase because of the potential for impaired metabolism in patients with personal or family history of malignant hyperthermia because... 

Short-term administration of barbiturates has no clinically significant effect on the hepatic, renal, or endocrine systems. A single induction dose of thiopental does not alter tone of the gravid uterus, but may produce mild transient depression of newborn activity. Drug-induced histamine release is occasionally seen. Barbiturates can induce fatal attacks of porphyria in patients with acute intermittent or variegate porphyria and are contraindicated in such patients. Unlike inhala-tional anesthetics and succinylcholine, barbiturates and all other parenteral anesthetics apparently do not trigger malignant hyperthermia. 

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