Anectine (succinylcholine chloride)

Anectine is a prescription medicine used to treat Neuromuscular Blockade. It may be used alone or with other medications.

Anectine belongs to a class of drugs called Neuromuscular Blockers, Depolarizing.

Side effects of Anectine

Rare reports of acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death have occurred after the administration of succinylcholine to apparently healthy children who were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne’s muscular dystrophy.

This syndrome often presents as peaked T-waves and sudden cardiac arrest within minutes after drug administration in healthy appearing children (usually males, most frequently 8 years of age or younger). There have also been reports in adolescents.

Therefore, when a healthy appearing infant or child develops cardiac arrest soon after succinylcholine administration not due to inadequate ventilation, oxygenation, or anesthetic overdose, immediate treatment for hyperkalemia should be instituted. This should include intravenous administration of calcium, bicarbonate, and glucose with insulin, with hyperventilation.

Due to the abrupt onset of this syndrome, routine resuscitative measures are likely to be unsuccessful. However, extraordinary and prolonged resuscitative efforts have resulted in successful resuscitation in some reported cases. In addition, in the presence of signs of malignant hyperthermia, appropriate treatment should be instituted concurrently.

Since there may be no signs or symptoms to alert the practitioner to which patients are at risk, it is recommended that the use of succinylcholine in children should be reserved for emergency intubation or instances where immediate securing of the airway is necessary, e.g. laryngospasm, difficult airway, full stomach, or for intramuscular use when a suitable vein is inaccessible.

This drug should be used only by individuals familiar with its actions, characteristics, and hazards.

Anectine may cause serious side effects including:

• cardiac arrest,
• life threatening elevation in body temperature,
• abnormal heart rhythms,
• fast or slow heart rate,
• high or low blood pressure,
• high blood potassium,
• prolonged slow breathing,
• increased eye pressure,
• muscle twitching,
• jaw rigidity,
• postoperative muscle pain,
• breakdown of muscle tissue (rhabdomyolysis),
• excessive salivation, and
• rash

Get medical help right away if you have any of the symptoms listed above.

The most common side effects of Anectine include:

• excessive saliva,
• muscle cramps, and
• muscle pain

Tell the doctor if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Anectine. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Dosage for Anectine

The dosage of succinylcholine should be individualized and determined by the clinician after careful assessment of the patient.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Solutions which are not clear and colorless should not be used.

Adults

For Short Surgical Procedures

• The average dose required to produce neuromuscular blockade and facilitate tracheal intubation is 0.6 mg/kg Anectine (succinylcholine chloride) Injection given intravenously.
• The optimum dose will vary among individuals and may be from 0.3 to 1.1 mg/kg for adults.
• Following administration of doses in this range, neuromuscular blockade develops in about 1 minute; maximum blockade may persist for about 2 minutes, after which recovery takes place within 4 to 6 minutes. However, very large doses may result in more prolonged blockade.
• A 5- to 10-mg test dose may be used to determine the sensitivity of the patient and the individual recovery time.

For Long Surgical Procedures

• The dose of succinylcholine administered by infusion depends upon the duration of the surgical procedure and the need for muscle relaxation. The average rate for an adult ranges between 2.5 and 4.3 mg per minute.
• Solutions containing from 1 to 2 mg per mL succinylcholine have commonly been used for continuous infusion.
• The more dilute solution (1 mg per mL) is probably preferable from the standpoint of ease of control of the rate of administration of the drug and, hence, of relaxation.
• This IV solution containing 1 mg per mL may be administered at a rate of 0.5 mg (0.5 mL) to 10 mg (10 mL) per minute to obtain the required amount of relaxation.
• The amount required per minute will depend upon the individual response as well as the degree of relaxation required.
• Avoid overburdening the circulation with a large volume of fluid. It is recommended that neuromuscular function be carefully monitored with a peripheral nerve stimulator when using succinylcholine by infusion to avoid overdose, detect development of Phase II block, follow its rate of recovery, and assess the effects of reversing agents.
• Intermittent IV injections of succinylcholine may also be used to provide muscle relaxation for long procedures. An IV injection of 0.3 to 1.1 mg/kg may be given initially, followed, at appropriate intervals, by further injections of 0.04 to 0.07 mg/kg to maintain the required degree of relaxation.

Pediatrics

• For emergency tracheal intubation or when immediate securing of the airway is necessary, the IV dose of succinylcholine is 2 mg/kg for infants and small children; for older children and adolescents, the dose is 1 mg/kg.
• Rarely, IV bolus administration of succinylcholine in infants and children may result in malignant ventricular arrhythmias and cardiac arrest secondary to acute rhabdomyolysis with hyperkalemia. In such situations, an underlying myopathy should be suspected.
• Intravenous bolus administration of succinylcholine in infants or children may result in profound bradycardia or, rarely, asystole.
• As in adults, the incidence of bradycardia in children is higher following a second dose of succinylcholine.
• The occurrence of bradyarrhythmias may be reduced by pretreatment with atropine.

Intramuscular Use

• If necessary, succinylcholine may be given intramuscularly to infants, older children, or adults when a suitable vein is inaccessible.
• A dose of up to 3 to 4 mg/kg may be given, but not more than 150 mg total dose should be administered by this route.
• The onset of effect of succinylcholine given intramuscularly is usually observed in about 2 to 3 minutes.

Compatibility and Admixtures

• Succinylcholine is acidic (pH 3.5) and should not be mixed with alkaline solutions having a pH greater than 8.5 (e.g., barbiturate solutions).
• Anectine (succinylcholine chloride) Injection is stable for 24 hours after dilution to a final concentration of 1 to 2 mg/mL in 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP.
• Aseptic techniques should be used to prepare the diluted product. Admixtures of Anectine (succinylcholine chloride) should be prepared for single patient use only.
• The unused portion of diluted Anectine (succinylcholine chloride) should be discarded.

Drugs that interact with Anectine

Drugs that may enhance the neuromuscular blocking action of succinylcholine include:

• promazine,
• oxytocin,
• aprotinin,
• certain non-penicillin antibiotics,
• quinidine,
• ß-adrenergic blockers,
• procainamide,
• lidocaine,
• trimethaphan,
• lithium carbonate,
• magnesium salts,
• quinine,
• chloroquine,
• diethylether,
• isoflurane,
• desflurane,
• metoclopramide, and
• terbutaline.

The neuromuscular blocking effect of succinylcholine may be enhanced by drugs that reduce plasma cholinesterase activity (e.g., chronically administered oral contraceptives, glucocorticoids, or certain monoamine oxidase inhibitors) or by drugs that irreversibly inhibit plasma cholinesterase.

If other neuromuscular blocking agents are to be used during the same procedure, the possibility of a synergistic or antagonistic effect should be considered.

Is Anectine safe to use while pregnant or breastfeeding?

• It is also not known whether succinylcholine can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.
• Succinylcholine should be given to a pregnant woman only if clearly needed.
• It is not known whether succinylcholine is excreted in human milk.
• Because many drugs are excreted in human milk, caution should be exercised following succinylcholine administration to a nursing woman.

Summary

Anectine is a prescription medicine used to treat Neuromuscular Blockade. It may be used alone or with other medications. Serious side effects include cardiac arrest, life threatening elevation in body temperature, abnormal heart rhythms, fast or slow heart rate, high or low blood pressure, high blood potassium, prolonged slow breathing, increased eye pressure, muscle twitching, jaw rigidity, postoperative muscle pain, breakdown of muscle tissue (rhabdomyolysis), excessive salivation, and rash.

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