Suksamethonium iodide - instructions for use, dose, side effects, contraindications

Excipients: sodium chloride, disodium edetate (disodium ethylenediaminetetraacetic acid), ascorbic acid, 0.1 M hydrochloric acid solution, water for injections saturated with carbon dioxide.

Description:Transparent colorless liquid.

Pharmacotherapeutic group:Miorelaxant depolarizing the peripheral action.

ATX: & nbsp

M.03.A.B Derived choline

Pharmacodynamics:

Depolarizing short-acting muscle relaxant. It causes a blockade of the neuromuscular transmission. Interacting with H-holinoretseptorami, causes depolarization of the terminal plate.The process extends to the adjacent membranes, a generalized disorganized contraction of myofibrils (ie, the blockade is preceded by muscle twitching - the result of a short-term relief of neuromuscular transmission). Membranes, remaining depolarized, do not respond to additional impulses, since the maintenance of muscle tone requires the arrival of repeated pulses, associated with repolarization of the terminal plate, spastic paralysis occurs. After intravenous injection, muscle relaxation occurs in the following sequence: eyelids, chewing muscles, muscles of the fingers, eyes, limbs, neck, back and abdomen, vocal cords; then intercostal muscles and diaphragm.

Causes an increase in cerebral blood flow and increased intracranial pressure. After intravenous administration, the effect develops after 54-60 seconds, after 2-3 min the muscle relaxation reaches a maximum and remains in full for 3 minutes. The duration of action is 5-10 minutes.

The severity of the action depends on the amount of the administered dose: 0.1 mg / kg - relaxation of skeletal muscles without significant effect on the respiratory system,0.2-1 mg / kg - complete relaxation of the musculature of the abdominal wall and respiratory muscles (there is a significant restriction or complete stop of spontaneous breathing). For a long relaxation of the muscles, a second injection is necessary. The rapid onset of the effect and the subsequent rapid restoration of muscle tone allow the creation of a controlled and controlled relaxation of the muscles.

Pharmacokinetics:After intravenous administration, it is distributed in plasma and extracellular fluid. More than 90% is hydrolyzed by cholinesterase of blood to succinic acid and choline. The half-life period is 90 sec with a normal level of pseudocholinesterase. It is excreted by the kidneys. It does not penetrate the intact blood-brain barrier. Do not cumulate.

Indications:

- disabling of spontaneous breathing (intracela intubation, bronchoscopy);

- complete miorelaxation (endoscopy, reversal of dislocations, reposition of fractures, gynecological, thoracic, abdominal operations);

- prevention of convulsions in electropulse therapy; poisoning with strychnine, tetanus (symptomatic therapy).

Contraindications:Hypersensitivity, malignant hyperthermia (incl.myasthenia gravis, congenital and dystrophic myotonia, Duchenne muscular dystrophy, closed charcoal glaucoma, acute liver failure, pulmonary edema, penetrating eye trauma, bronchial asthma, hyperkalemia, breast age (up to 1 year), pregnancy.

Carefully:With caution, the decrease in serum pseudocholinesterase activity (terminal stage of hepatic insufficiency, anemia, cachexia, prolonged fasting, chronic infections, common burns, trauma), postpartum period, tetanus, tuberculosis, malignant neoplasms, chronic renal failure, myxidemia, systemic connective tissue diseases, state after a plasma transfusion, plasmapheresis, artificial circulation, acute and chronic intoxication with insecticides - inhibitors of cholinesterases (When ingested) or anticholinesterase drugs (neostigmine, physostigmine, distigmin, phospholine), the simultaneous use of drugs competing with succinylcholine for cholinesterase (procaine intravenously), emergency surgery in patients with a "full stomach".

Dosing and Administration:

Dosage regimen: intravenously (struyno, drip).

Adults: intravenously slow, jet or drip (for a long drop infusion use 0.1% solution). Depending on the clinical situation, with intravenous administration, a single dose varies from 100 μg / kg to 1.5-2 mg / kg. For tracheal intrusion, 0.2-0.8 mg / kg; for miorelaxation and disabling of spontaneous breathing - 0.2-1 mg / kg; for the relaxation of skeletal musculature in the direction of dislocation and reposition of bone fragments in fractures - 0.1-0.2 mg / kg; for endoscopy - 0.2 mg / kg; for prevention of complications during electropulse therapy (seizures, muscle and tendon laceration) - 0.1-1 mg / kg intravenously, but not more than 150 mg.

For a long relaxation of the musculature throughout the operation can be introduced fractionally, after 5-7 minutes at 0.5-1 mg / kg. Repeated doses last longer.

Intramuscularly used in children in doses up to 2.5 mg / kg, but not more than 150 mg; intravenously - 1-2 mg / kg.

Side effects:Allergic reactions (anaphylactic shock, bronchospasm); hyperkalemia, lowering of arterial pressure, arrhythmias, bradycardia (more often in children, with repeated administration of children and adults), conduction disorder, cardiogenic shock; increased intraocular pressure, hypersalivation, fever,myalgia (in the postoperative period); long paralysis of the respiratory muscles (associated with a genetically determined violation of the formation of serum cholinesterase); rarely - rhabdomyolysis with the development of myoglobinemia and myoglobinuria.

Overdose:

Symptoms: stop breathing.

Treatment: artificial ventilation of the lungs, in the case of a decrease in the content of cholinesterase in the serum, a fresh blood transfusion.

Interaction:

Pharmaceutically incompatible with donor blood and blood products (hydrolysis occurs), blood and serum preservatives; with solutions of barbiturates and alkaline solutions (a precipitate is formed). Compatible with isotonic solutions of sodium chloride, Ringer's solution, 5% fructose solution and 6% dextran solution. Anticholinesterase drugs, procaine, procainamide, lidocaine, veralamil, beta-adrenoblockers, aminoglycoside antibiotics, amphotericin B, clindamecin, cyclopropane, propanidide, organophosphate insecticides, salts of Mg2 + and Li +, quinidine, quinine, chloroquine, pancuronium strengthen and prolong the muscle relaxant effect. Compatible with other muscle relaxants, narcotic analgesics.Strengthens the cardiac effects of cardiac glycosides (bradycardia). Reduces the effectiveness of antimiasthenic drugs.

Hypogens containing agents for general anesthesia are enhanced, and thiopental sodium and atropine reduce the undesirable effect on the cardiovascular system. Drugs that have the potential to reduce cholinesterase activity (aprotinin, diphenhydramine, promethazine, estrogens, oxytocin, glucocorticosteroids in high doses, oral contraceptives), enhance and prolong the muscle relaxant effect of suxamethonium.

Special instructions:

Applied only in the conditions of a specialized department with the availability of equipment for artificial ventilation and personnel who own this technique, and against a background of general anesthesia.

Pre-introduction 1 minute prior to infusion of suxamethonium iodide with a drug of 3-4 mg d-tubocurarin or 10-15 mg of diplatin prevent fibrillar muscle twitching and the subsequent appearance of muscle pain.

With the appropriate dose and repeated administration can be used for longer operations, however, for prolonged relaxation of the muscles, nondepolarizing muscle relaxants are usually used,which are administered after a preliminary intrusion of the trachea against a background of suxamethonium iodide.

Slow introduction of the drug, as well as a preliminary intravenous injection of atropine at a dose of 1-1.5 mg significantly prevents bradycardia and increased bronchial secretion.

Patients with renal insufficiency (without signs of hyperkalemia and neuropathy) are given a single dose of the drug in moderate doses, but do not apply for multiple injections or at elevated doses because of the risk of developing hyperkalemia.

Prolonged muscle relaxation with possible apnea can be caused by several reasons: "atypical" cholinesterase of blood serum, hereditary insufficiency of serum cholinesterase, or a temporary decrease in its level. If the drug is injected repeatedly and 25-30 minutes after the last injection, the patient does not restore muscle tone, there is superficial breathing, one can think of the transition of the depolarizing unit to an antidepolarizing one (the occurrence of a "double block"). To remove this effect, it is necessary to use proserin according to the usual method: the vein is administered first atropine in a dose of 0.5-0.7 mg (0.5-0.7 ml of a 0.1% solution), the pulse becomes more frequent and after 1 or 2 minutes intravenously injected prozerin at a dose of 1.5 mg (3 ml 0.05 % solution).

In children, young patients and women (mainly in the vagotonics), a short-term bradycardia may occur, and in some cases, an asystole.

After 10-12 hours after using the drug, muscle pain may occur.

With repeated administration of the drug, excessively prolonged muscle relaxation and prolonged apnea can sometimes develop.

Form release / dosage:

A solution for intravenous and intramuscular administration of 20 mg / ml.

Packaging:5 ml per ampoules; 10 ampoules with instructions for use in a pack of cardboard with corrugated ribbon or special nests. 10 ampoules per contour cell package. Each contour pack with instructions for use in a pack of cardboard.

Storage conditions:

List A. In a dark place inaccessible to children, at a temperature of no higher than 5 ° C, freezing is not allowed.

Shelf life:1 year 6 months

Terms of leave from pharmacies:On prescription

Registration number:LSR-010924/09

Date of registration:31.12.2009

The owner of the registration certificate:Company DEKO, LLC Company DEKO, LLC Russia

Manufacturer: & nbsp

Company DEKO, LLC Russia

Representation: & nbspCompany DEKO, LLCCompany DEKO, LLC

Information update date: & nbsp25.08.2015

Illustrated instructions

Instructions

Suxamethonium iodide (Suxamethonium iodide)