Succinylcholine

(Anectine)

Neuromuscular Blocking Agents & Reversals

Succinylcholine is a depolarizing neuromuscular blocking agent with the fastest onset (30-60 sec) and shortest duration (5-10 min) of all NMBAs. It mimics acetylcholine by binding to nicotinic receptors, causing initial fasciculations followed by paralysis. The drug is metabolized by plasma cholinesterase (pseudocholinesterase), making its duration dependent on this enzyme's activity. Succinylcholine remains the drug of choice for rapid sequence intubation (RSI) despite its numerous side effects, which include hyperkalemia, malignant hyperthermia trigger, and bradycardia. It is contraindicated in burn patients >24 hours, major trauma >48 hours, and neuromuscular disorders due to risk of life-threatening hyperkalemia.