Succinylcholine: Adverse Effects (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 Well, that sucks. Yeah, now we're going to talk about the somewhat darker side of succinylcholine. If the patient has low pseudocholinesterase activity, meaning ase is an enzyme and it goes after the choline, right, the acetylcholine. If there is low enzymatic activity, then you're not going to have this rapid degrade that we're used to. So, it's going to hang around a lot longer. That means that in some patients paralysis could last for hours. So, it's not supposed to, but if they don't have enough of that enzyme, it could last for hours. So, you're going to want to watch that patient very closely. We know how the drug is supposed to work, but we also know occasionally you may experience this effect with your patient.

    00:48 Between 10% and 70% of patients that get succs experience postoperative muscle pain. Yeah, that sucks too. So, 10% to 70% is a really wide range, but they could have some type of postoperative muscle pain. So, that's important, that nurses who are caring for a patient after a procedure or surgery know that the patient received this medication. Now, it's most common in the neck, shoulders, and back. So, if patients are complaining about back pain, it might be a result of that medication. The pain develops 12 to 24 hours after the surgery, and it may hang around for several hours to several days. So, you know where it develops usually, neck, shoulders, and back; may develop within 12 to 24 hours after surgery; and we think it might be caused because of the muscle contractions that occur during that initial phase of acetylcholine action. So, this drug in particular, a wide range of patients may or may not have this experience. So, if I'm taking care of a patient, it could likely be the next shift before the patient starts to complain of this feeling. So, know to expect it, know it can happen, and just help your patient become more comfortable. Well, this one sucks too, hyperkalemia. See succs promotes the release of potassium from the tissues. So, after a patient has had this medication, I'm going to want to keep an eye on that. Now, rarely the potassium release is sufficient to cause severe hyperkalemia. So, we might notice a little bump up in it, but it shouldn't be anything too severe. There have been a few patients, rare, but it has happened, that resulted in cardiac arrest from the hyperkalemia. Again, this is very rare that it happens.

    02:42 Significant hyperkalemia is most likely to occur in patients that have had major burns, multiple trauma, they've had some really severe demyelination of the skeletal muscle or the upper motor neuron injury. So, this is not something that happens very often, but when it does it can have a really bad outcome. So, death from the cardiac arrest has happened. The people that were most likely to have significant high potassium though have had some really significant injuries, major burns, multiple trauma, denervation of skeletal muscle or upper motor neuron injury. Okay, so you want to remember now that hyperkalemia is a risk that could happen, does not happen very often, but when it does could be really negative. Now, this one really sucks. Some patients have a genetic risk of malignant hyperthermia. Okay, this is life-threatening So, when they get the succs, afterwards this is the response that they have. Now, malignant hyperthermia is life-threatening, it's a crisis, and it can be fatal if not treated immediately.

    03:53 So, the most likely place this happens is in surgery because this would be used before procedure. They have a special cart and very specific procedure on how the surgery staff will respond to malignant hyperthermia crisis. But I want you to be familiar with what this is. It's rare, potentially life-threatening fatal condition that can be triggered by succs So, everyone is trained in this, everyone knows how to recognize it, and how to respond. But if you've never heard of it before, let's walk through it so you'll understand what it is. They'll have severe muscle rigidity. Their temperature will go way up. That's why it gets its name malignant hyperthermia. So, this means a really dangerous elevated temperature. Now, they're going to have some strange cardiac dysrhythmias with it. They're also going to have a very unstable blood pressure. They're going to have some electrolytes just go wacky, and they're going to have metabolic acidosis. Okay, those are clearly the reasons why a patient could die from this if not treated. Muscle rigidity is one thing, but let's look at their basic vital signs of life.

    05:03 Temp is going crazy. If it gets too high, you know you're going to have damage to the brain.

    05:08 The heart isn't functioning well. It's going to be unstable, dysrhythmias, and then I'm going to have electrolyte and I'm going to have a pH imbalance being in metabolic acidosis and electrolytes that are just not normal. So, what do we do? Well, obviously you immediately stop the succs if you can when you realize this is happening. You want to try and get that body temperature down. They'll use external ice packs, and they'll use infusions of cold saline.

    05:36 So, there's a very specific procedure. You won't just pop into one of these. When this happens, the team will immediately come together and go into action. So, they'll administer IV dantrolene. That's something that we'll use to kind of help deal with that muscle rigidity, and the dantrolene acts directly on the skeletal muscle. It's going to reduce the metabolic activity which will stop the heat generation. So, that's the goal. Cool them down externally and internally and give dantrolene to deal with that skeletal muscle that's driving that temperature up. Now, dantrolene is used for some other things. You'll also see it's used in a neuroleptic malignant syndrome, but it's a direct-acting skeletal muscle relaxant. So, I want you to make sure that you pause here for just a minute, whether you pause the video or not, and make sure you focus on the name of this drug and the purpose that we use it. We use it for malignant hyperthermia and see if you can recall how it works without looking at that previous slide. Okay, so what's going to be the effect of the dantrolene? What one specific vital sign will this go after? Right, the temperature. Good job. So, let's talk about the pros and cons of this drug. Now, it causes a reduction of heat, and that helps us also deal with the muscle rigidity, and the effects are reported within just a few minutes of the patient receiving it, but here are the cons: It can be really tough on the liver, so we're going to keep an eye on their liver following administration. Now, if we know the patient has known liver problems, then it should really going to be a more difficult situation, but they're going to have to make the decision what's worse, the risk of the liver or what's going on with the current level of malignant hyperthermia.

    About the Lecture

    The lecture Succinylcholine: Adverse Effects (Nursing) by Rhonda Lawes, PhD, RN is from the course Peripheral Nervous System (PNS) Medications (Nursing).

    Included Quiz Questions

    1. Neck
    2. Shoulder
    3. Back
    4. Legs
    5. Head
    1. 12-24 hours after surgery
    2. 2-6 hours after drug administration
    3. 2-4 days after surgery
    4. When the effect of anaesthesia is over
    1. Malignant hyperthermia
    2. Hyperkalemia
    3. Muscle contractions
    4. Cardiac arrest
    1. Reducing the dose of succinylcholine immediately
    2. Using external icepacks
    3. Administering dantrolene intravenously
    4. Infusion of cold saline

    Author of lecture Succinylcholine: Adverse Effects (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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