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Therapeutic indications
For the production of skeletal muscle relaxation in anaesthesia. Suited for procedures requiring only brief relaxation such as endotracheal intubation, endoscopic examinations, orthopaedic manipulations, short surgical procedures and electro-convulsive therapy.
Dose and method of administration
An initial test dose of 0.1 mg/kg may be given intravenously to determine the patient's response.
ADULT
For short procedures, such as endotracheal intubation the usual adult dose is 0.6 mg/kg (range 0.3-1.1 mg/kg) administered IV over 10 to 30 seconds. This dose produces muscle relaxation in about 60 seconds and has a duration of approximately 4 to 6 minutes. Larger doses produce more prolonged muscle relaxation.
For more prolonged surgical procedures in an adult, suxamethonium is commonly given by IV infusion at a rate of 2.5 -4.3 mg/minute. When given by intravenous infusion suxamethonium should be diluted to 0.1 to 0.2% (1-2 mg/mL) in 5% dextrose solution or sterile isotonic saline.
CHILDREN
Neonates and premature infants may be relatively resistant to suxamethonium.
The usual paediatric IV dose is 1 to 2 mg/kg. If necessary, additional doses may be administered in accordance with patient's response. Continuous IV infusions of suxamethonium are considered unsafe in neonates and children because of the risk of inducing malignant hyperthermia. Intravenous bolus in children may result in profound bradycardia or on occasion asystole. This tends to be more common after a second dose. Pre-treatment with atropine can reduce the risk of bradycardia.
When a suitable vein is inaccessible, suxamethonium may occasionally be given by intramuscularinjection. A suggested IM dose for adults and children may be up to 2.5 mg/kg but the total doseshould not exceed 150 mg.
Diluted solutions of suxamethonium must be used within 24 hours of preparation. Discard unused solutions.
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