#高警訊藥品

肌肉鬆弛劑 Neuromuscular blockade for endotracheal intubation, surgery, or mechanical ventilation

Neuromuscular Blocker Agent
Acts similar to acetylcholine, produces depolarization of the motor endplate at the myoneural junction which causes sustained flaccid skeletal muscle paralysis produced by state of accommodation that develops in adjacent excitable muscle membranes.

Onset of action:
1. IM: (Infants and Children) 3 to 4 minutes; (Adults) 2 to 3 minutes
2. IV: (Neonates and Infants) ~30 seconds; (Children and Adolescents) 35 to 55 seconds; (Adults) <60 seconds
Duration:
IM: 10 to 30 minutes; IV: ~4 to 10 minutes
Distribution:
Vd higher in neonates and infants due to larger ECF volume; higher IV doses necessary.
Metabolism:
Rapidly hydrolyzed by plasma pseudocholinesterase to inactive metabolites.
Excretion:
Urine (~10% excreted unchanged)

1. Hypersensitivity to succinylcholine or any component of the formulation
2. Personal or familial history of malignant hyperthermia; skeletal muscle myopathies
3. Use after the acute phase of injury following major burns, multiple trauma, extensive denervation of skeletal muscle, or upper motor neuron injury.

Succinylcholine should be used during pregnancy only when clearly needed.

It is not known whether succinylcholine is distributed into human milk, and the manufacturers recommend that the drug be used with caution in nursing women.

1. Cardiovascular: Abnormal T waves on ECG (peaked T-wave), asystole, bradycardia, cardiac arrhythmia, hypertension, hypotension, tachycardia, ventricular arrhythmia
2. Dermatologic: Skin rash
3. Endocrine & metabolic: Hyperkalemia
4. Gastrointestinal: Sialorrhea
5. Hypersensitivity: Anaphylaxis, hypersensitivity reactions
6. Nervous system: Malignant hyperthermia
7. Neuromuscular & skeletal: Fasciculations, jaw tightness, postoperative myalgia, rhabdomyolysis, state of neuromuscular blockade
8. Ophthalmic: Increased intraocular pressure
9. Respiratory: Apnea, respiratory depression
10. Miscellaneous: Tachyphylaxis

IM:
Up to 3 to 4 mg/kg, maximum total dose: 150 mg
IV:
1. Short procedures (Intubation): 0.6 mg/kg (range: 0.3-1.1 mg/kg)
2. Long surgical procedures (intermittent administration): Initial 0.3-1.1 mg/kg; administer 0.04-0.07 mg/kg at appropriate intervals as needed

Endotracheal intubation, emergent:
1. IM:
(1) Infants <6 months (Limited data available): 4 to 5 mg/kg; pharmacokinetic data suggests that young infants typically require doses on the higher end of this range
(2) Infants ≥6 months and Children: 4 mg/kg; maximum dose: 150 mg/dose
(3) Adolescents: 3 to 4 mg/kg; maximum dose: 150 mg/dose
2. IV:
(1) Infants ≤6 months: 2 to 3 mg/kg/dose
(2) Infants >6 months: 1 to 2 mg/kg/dose; doses up to 3 mg/kg/dose have been recommended
(3) Children: 1 to 2 mg/kg/dose
(4) Adolescents: 1 to 1.5 mg/kg/dose

No dosage adjustments provided in the manufacturer's labeling.

No dosage adjustments provided in the manufacturer's labeling.