Once Succinylcholine “Sux” is unrefrigerated, expiration is in 14 days.
Succinylcholine PACU Storage Protocol
Succinylcholine (Sux) is required to be present in the PACU during patient care. Sux should be kept in a clearly labeled section of your PACU medication box making it readily available for an emergency airway. It may also be stored on ice in a portable cooler placed in the PACU.
Succinylcholine is stored in a refrigerator at 36° to 46°F (2° to 8°C). Once Sux is first removed from the refrigerator and exposed to room temperature in the PACU, it should be labeled with a 14-day expiration date. Sux should be returned to the refrigerator at the end of patient care each day. .. Succinylcholine exposed to room temperature should be properly disposed of on day 28.
What is succinylcholine?
Succinylcholine, also known as suxamethonium (Sux) and by trade names such as Anectine® and Quelicin®, is an emergency medication required to be present in the PACU and operating room during patient care and readily available. It is kept in a clearly labeled section of your medication box.
Succinylcholine is a rapidly acting depolarizing muscle relaxant used to cause short-term paralysis that can be given intravenously (IV) or intramuscularly (IM). When used intravenously (IV) onset of action is generally within one minute and effects last for up to 10 minutes.
How should succinylcholine be stored?
Succinylcholine should be stored in the refrigerator at 36° to 46°F (2° to 8°C). Once succinylcholine is first removed from the refrigerator, it should be used within 14 days but can be stored at room temperature for short periods at not more than 77°F (25°C) before being returned to the refrigerator during those 14 days.
Properly dispose of unrefrigerated succinylcholine or until the manufacturer’s expiration date on each vial if refrigerated. The Joint Commission (TJC) recommends that you abide by the package insert for beyond use dates (BUD) for succinylcholine. The Joint Commission (TJC), formerly the 1987 Accreditation of Healthcare Organizations (JCAHO, pronounced “Jay-co”), administers voluntary accreditation programs for hospitals and other healthcare organizations. The Joint Commission standards function as the foundation for healthcare organizations to gauge and enhance their performance.
The shelf life of unrefrigerated succinylcholine chloride injection?
Solutions containing 20 mg/ml of succinylcholine chloride stored at 25 and 40 degrees C. Allowing for the effects of pH adjustment during manufacturer and degradation during shipping, losses of 7.0% and 9.0% potency can be expected after storage at 25 degrees C for four and six weeks, respectively.
How much does succinylcholine cost?
The range for the cost per dose of succinylcholine can be large ($9 to $93) and will depend on your contracts with your distribution company. Our best estimate of the cost per dose was $20. Some studies show that the true cost per dose of succinylcholine from society’s perspective is more than 20 times the acquisition cost.
FDA Warning on the use of Succinylcholine Chloride Injection, USP
Warning Risk Of Cardiac Arrest From Hyperkalemic Rhabdomyolysis There have been rare reports of acute rhabdomyolysis with hyperkalemia followed by ventricular dysrhythmias, cardiac arrest, and death after the administration of succinylcholine to apparently healthy children who were subsequently found to have undiagnosed skeletal muscle myopathy, most frequently Duchenne’s muscular dystrophy. This syndrome often presents as peaked T-waves and sudden cardiac arrest within minutes after the administration of the drug in healthy appearing children (usually, but not exclusively, males, and most frequently 8 years of age or younger). There have also been reports in adolescents. Therefore, when a healthy appearing infant or child develops cardiac arrest soon after administration of succinylcholine not felt to be due to inadequate ventilation, oxygenation, or anesthetic overdose, immediate treatment for hyperkalemia should be instituted. This should include administration of intravenous calcium, bicarbonate, and glucose with insulin, with hyperventilation. Due to the abrupt onset of this syndrome, routine resuscitative measures are likely to be unsuccessful. However, extraordinary and prolonged resuscitative efforts have resulted in successful resuscitation in some reported cases. In addition, in the presence of signs of malignant hyperthermia, appropriate treatment should be instituted concurrently. Since there may be no signs or symptoms to alert the practitioner to which patients are at risk, it is recommended that the use of succinylcholine in children should be reserved for emergency intubation or instances where immediate securing of the airway is necessary, e.g. laryngospasm, difficult airway, full stomach, or for intramuscular use when a suitable vein is inaccessible (see PRECAUTIONS: Pediatric Use and DOSAGE AND ADMINISTRATION).
Manufacturer Warning on the use of Anectine® (succinylcholine, suxamethonium)
Succinylcholine is contraindicated in persons with a personal or familial history of malignant hyperthermia, skeletal muscle myopathies, and known hypersensitivity to the drug. It is also contraindicated in patients after the acute phase of injury following major burns, multiple trauma, extensive denervation of skeletal muscle, or upper motor neuron injury, because succinylcholine administered to such individuals may result in severe hyperkalemia which may result in cardiac arrest (see WARNINGS). The risk of hyperkalemia in these patients increases over time and usually peaks at 7 to 10 days after the injury. The risk is dependent on the extent and location of the injury. The precise time of onset and the duration of the risk period vary.
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