First-lineAnectine / Scoline
Suxamethonium
Depolarising neuromuscular blocker
Rapid sequence induction paralysing agent in obstetric GA.
IV
First-line for
- Rapid sequence induction for obstetric GA (Category 1 LSCS, failed intubation)
- Laryngospasm reversal
Mechanism
Non-competitive nicotinic ACh receptor agonist → sustained depolarisation → paralysis; metabolised by plasma cholinesterase (~5 min).
"Sux = SUX side effects but SUB-second onset"
- Hyperkalaemia in burns/spinal injury >48h old
- Malignant hyperthermia trigger
- Prolonged block if plasma cholinesterase deficiency
Dosing
- RSI
- 1–1.5 mg/kg IV
Contraindications
- AbsolutePersonal or family history of malignant hyperthermia
- AbsoluteBurns >24 h old, denervation, prolonged immobilisation (hyperK)
- AbsolutePlasma cholinesterase deficiency (relative — use rocuronium)
Side effects
- Fasciculations, myalgia
- Hyperkalaemia
- Bradycardia (repeat dose)
- Malignant hyperthermia
- Anaphylaxis (top NMB culprit)
Fetal & maternal notes
- • Highly ionised — minimal placental transfer at RSI doses
Key interactions
Aminoglycosides / Mg
CautionProlonged block
Clinical pearls
- 💡 Rocuronium + sugammadex is a modern alternative for RSI
- 💡 Have adrenaline and dantrolene protocol ready
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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