Suxamethonium

Structural formula
	Structural formula of dichloride
General
Non-proprietary name	Suxamethonium
other names	Succinylcholine; 2,2 ′ - [(1,4-Dioxobutane-1,4-diyl) bis (oxy)] bis ( N , N , N -trimethylethanaminium);
Molecular formula	C 14 H 30 N 2 O 4
External identifiers / databases
PubChem	5314
ChemSpider	5123
DrugBank	DB00202
Wikidata	Q424378
Drug information
ATC code	M03 AB01
Drug class	Muscle relaxant
properties
Molar mass	290.40 g · mol -1
safety instructions
	Please note the exemption from the labeling requirement for drugs, medical devices, cosmetics, food and animal feed
GHS labeling of hazardous substances (Dichloride dihydrate) danger
H and P phrases	H: 301
	P: ?
	As far as possible and customary, SI units are used. Unless otherwise noted, the data given apply to standard conditions .

Suxamethonium or succinylcholine (also known as succinylbischoline or succinyldicholine ) is the only depolarizing muscle relaxant used in human medicine . It is used to induce temporary muscle paralysis (including the respiratory muscles) and thereby enable ventilation .

Mechanism of action

The substance acts as an agonist on the acetylcholine receptors of the motor endplate . A permanent depolarization (overexcitation) eventually leads to muscle paralysis (depolarization block).

The maximum onset of action of succinylcholine is rapid (about 1 minute) and the duration of action is short (3–10 minutes). The intravenously mg in a dose of 1 to 1.5 / kg body weight, administered substance is in clinical anesthesia as a muscle relaxant of choice for induction of anesthesia in non-fasting patients ( rapid sequence induction ) who are at increased risk of aspiration have .

The substance is eliminated in the liver and in the blood plasma via pseudocholinesterase .

Side effects

Due to the mechanism of action of the substance, muscle twitches ( fasciculations ) of different strengths are triggered briefly before the onset of paralysis . A loss of muscle cells triggered by the fasciculations can lead to a critical increase in the serum potassium level and corresponding complications (cardiac arrhythmia, bradycardia , cardiovascular arrest ). The substance should therefore not be used in patients with diseases in which the stability of the cell membranes is impaired (such as burns , multiple trauma ). In patients who have been immobile for a longer period of time (e.g. because they are bedridden), the above-mentioned complications can also occur due to the increased sensitivity of the acetylcholine receptors .

In rare cases, succinylcholine can trigger a life-threatening metabolic disease ( malignant hyperthermia ) and must therefore not be used in patients with an existing predisposition to pre-existing diseases (such as muscular dystrophy ).
Furthermore, the intraocular pressure can increase due to the fasciculations ; it should therefore not be used for injuries to the eyeball either.
Some of the patients treated with succinylcholine may experience muscle pain (so-called myalgia) after the operation, which is similar in appearance to sore muscles . These symptoms can last up to a week.

In rare cases (if the effect of the enzyme pseudocholinesterase is reduced ), the effect can be greatly prolonged, so that longer post-ventilation may be necessary.

Succinylcholine, which causes respiratory arrest , is also used in the USA for lethal injection for those sentenced to death .

Trade names

Monopreparations

Lysthenon (D, A, CH), Midarine (CH), Pantolax (D), Succinolin (CH)

literature

JU Schreiber, T. Fuchs Buder: Neuromuscular Blockade , in: Bardenheuer, Forst, Rossaint, Spahn (Ed.): Further training for anesthetists 2006 , Springer, Heidelberg, ISBN 978-3-540-47962-8 .
Philip L. Liu: Fundamentals of Anesthesiology , Urban and Fischer, Stuttgart 2001, ISBN 3-437-11625-8 .
Norbert Roewer, Holger Thiel: Anesthesia compact , Thieme, Stuttgart, ISBN 3-13-116581-2
Martin Lindig: Pain, Sedation and Anesthesia. In: Jörg Braun, Roland Preuss (Ed.): Clinic Guide Intensive Care Medicine. 9th edition. Elsevier, Munich 2016, ISBN 978-3-437-23763-8 , pp. 581–618, here: pp. 613–616.

Individual evidence

↑ External identifiers of or database links to suxamethonium dichloride dihydrate : CAS number: 6101-15-1, EC number: 630-401-1, ECHA InfoCard: 100.158.700 , PubChem : 656867 , ChemSpider : 571132 , Wikidata : Q27130900 .

↑ External identifiers or database links for suxamethonium dichloride: CAS number: 71-27-2, EC number: 200-747-4, ECHA InfoCard: 100.000.680 , PubChem : 22475 , ChemSpider : 21080 , Wikidata : Q12455154 .

↑ There is not yet a harmonized classification for this substance . What is shown is a labeling of 2,2 '- [(1,4-dioxobutane-1,4-diyl) bis (oxy)] bis (N, N, N-trimethylethanaminium) chloride hydrate (1: 2: 2) in the Classification and Labeling Inventory of the European Chemicals Agency (ECHA), accessed on July 3, 2020.

↑ Julia Borsch: Executions in the USA: What is in the lethal injections? In: Deutsche Apotheker Zeitung. May 17, 2016, accessed July 2, 2020 .

[1] External identifiers of or database links to suxamethonium dichloride dihydrate : CAS number: 6101-15-1, EC number: 630-401-1, ECHA InfoCard: 100.158.700 , PubChem : 656867 , ChemSpider : 571132 , Wikidata : Q27130900 .

[2] External identifiers or database links for suxamethonium dichloride: CAS number: 71-27-2, EC number: 200-747-4, ECHA InfoCard: 100.000.680 , PubChem : 22475 , ChemSpider : 21080 , Wikidata : Q12455154 .

[3] Template: CL Inventory / not harmonized There is not yet a harmonized classification for this substance . What is shown is a labeling of 2,2 '- [(1,4-dioxobutane-1,4-diyl) bis (oxy)] bis (N, N, N-trimethylethanaminium) chloride hydrate (1: 2: 2) in the Classification and Labeling Inventory of the European Chemicals Agency (ECHA), accessed on July 3, 2020.

[4] Julia Borsch: Executions in the USA: What is in the lethal injections? In: Deutsche Apotheker Zeitung. May 17, 2016, accessed July 2, 2020 .