Depolarising neuromuscular blocker

Suxamethonium chloride

Brand names: Anectine, Quelicin

Adult dose

Dose: Intubation: 1–1.5 mg/kg IV (1.5 mg/kg for RSI). Children: 1–2 mg/kg IV

Route: IV/IM

Frequency: single induction

Clinical pearls

RSI standard at 1.5 mg/kg — onset 60s, duration 5–8 min
Rocuronium 1.0–1.2 mg/kg + sugammadex is alternative

Contraindications

Plasma cholinesterase deficiency
Personal/FH malignant hyperthermia
Hyperkalaemia
Major burns/trauma >24h
Spinal cord injury >24h
Severe sepsis (>72h)
Neuromuscular disorders
Penetrating eye injury

Side effects

Hyperkalaemia (severe — life-threatening in burns/SCI/sepsis)
Malignant hyperthermia
Bradycardia (esp. children, repeat dose)
Myalgia
Raised intraocular/intragastric pressure
Anaphylaxis

Interactions

Aminoglycosides
Magnesium
Volatile anaesthetics
Cholinesterase inhibitors (prolonged)
Cardiac glycosides

Monitoring

Train-of-four
K+
Temp
ECG

Reference: BNF; AAGBI; UK guidelines; https://bnf.nice.org.uk/drugs/suxamethonium-chloride/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways