## Succinylcholine: Pharmacokinetics and Clinical Profile **Key Point:** Succinylcholine is a depolarizing neuromuscular blocking agent with the shortest duration of action (5–10 minutes) among all NMBAs, making it the drug of choice for rapid sequence intubation. ### Metabolism Succinylcholine is hydrolyzed by plasma cholinesterase (pseudocholinesterase / butyrylcholinesterase) in the blood and tissues. This rapid enzymatic degradation accounts for its ultra-short duration. **High-Yield:** Patients with pseudocholinesterase deficiency (genetic variants) experience prolonged apnea after succinylcholine administration and require mechanical ventilation until the drug is cleared. ### Comparison with Other NMBAs | Agent | Type | Metabolism | Duration | Use | |-------|------|-----------|----------|-----| | Succinylcholine | Depolarizing | Plasma cholinesterase | 5–10 min | RSI, short procedures | | Rocuronium | Non-depolarizing | Hepatic | 30–40 min | Intubation, maintenance | | Vecuronium | Non-depolarizing | Hepatic | 30–40 min | Intubation, maintenance | | Cisatracurium | Non-depolarizing | Ester hydrolysis + Hofmann | 40–60 min | Organ failure patients | **Clinical Pearl:** Although succinylcholine has the shortest duration, it is associated with side effects (hyperkalemia, malignant hyperthermia, fasciculations) that limit its use in certain patient populations. [cite:Gupta & Rao Anesthesia 3e Ch 18]
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