Potential Adverse Outcomes of Succinylcholine Used for Rapid Sequence Intubation

Potential Adverse Outcomes of Succinylcholine Used for Rapid Sequence Intubation Courtney Watts, PharmD Candidate, Erin Archibald, PharmD Candidate, Jennifer Felder, PharmD Candidate, Leslie A. Hamilton, PharmD, BCPS, Michael Crain, MD

Purpose:  Succinylcholine, a depolarizing neuromuscular blocker used during intubation, has a black box warning for use in pediatric patients due to the risk of rhabdomyolysis, hyperkalemia, ventricular arrhythmias, and cardiac arrest in patients with skeletal muscle myopathy, though it is very commonly used in adult patients.  The purpose of this study was to outline potential adverse outcomes related to the use of succinylcholine for rapid sequence intubation in an adult patient.

Methods: To describe the hospital course of a 58 year old patient admitted for the placement of a biventricular cardioverter defibrillator.  During intubation for the procedure, the patient went into asystole and arrested.  The patient received etomidate, fentanyl, isoflurane, midazolam, and succinylcholine during rapid sequence intubation.

Results: After the initial asystole, the patient developed hyperkalemia and rhabdomyolysis and ultimately expired after another cardiac arrest.

Conclusion: Though uncommon, succinylcholine is a potential cause of hyperkalemia, rhabdomyolysis, and cardiac arrest in susceptible patients.