Succ vs Etomidate

"Succs" or Succinylcholine is a muscle relaxant. Etomidate is an anesthesia induction drug causing hypnosis. You never give Succs alone without Etomidate or some other drug for induction of anesthesia. Otherwise, you have a paralyzed patient with no hypnosis on board. For the most part, Succs does not effect cardiovascular numbers either. Although, it does cause some histamine release and bradycardia has been seen in pediatric patients; it is a very cardiac stable drug. Hope this helps.

Hi CRNA, yes, we always give some sedative with succ, as I mentioned, usually propofol, versed, etc. I was just wondering about the trend others are seeing, though, as I'm seeing certain docs use succ less and less, and trending towards etomidate for bedside procedures. I believe, though, that succ can effect HR and rhythm, though. Perhaps that is why?

Succs is avoided in pts who have been bedridden or pts with a high serum K. Due to the mechanism of action of the drug, it causes K to be released from the motor end plate. Therefore it is avoided in bedridden pts and ones with high K, because it could lead to a sudden surge of extra cellular K and cardiac arrest. Anesthetic drugs are all chosen with the specific pts comprbidities in mind so that they remain hemodynamically stable and safe.

Thank you for taking the time to answer, CRNA!

Most of our patients are contraindicated to get Succ for the reasons mentioned above. Muscular disorders, bedridden ESRD patients, etc.

Our go-to is Etomidate and Versed. If 2 rounds of each doesn't work out (still biting down, can't flex their head) then we call anesthesia and they bring the big guns. Only they are allowed to push Succ for intubations at our hospital.

Amidate is a pretty forgiving drug therefore it is a good choice for inducing critical care pts. It is very cardiac stable and often pts. will continue to breathe, unlike propofol which can completely depress respirations. Obviously, when intubating "in not so good conditions" such as the ICU it is always good to keep the pt. breathing or not paralyzed in case one runs into a "cannot intubate", or even worse, "a cannot ventilate situation."

We use Etomidate exclusively for bedside procedures (reduction of dislocated joints). For intubation, we combine Succ with Etomidate pre-intubation as a 2 drug combo. For procedures, Etomidate is short acting with the patient waking back up in minutes rather than hours and discharges are more expedient after the required monitoring time and without many residual side effects.

Now am seeing a trend towards etomidate

I found it quite interesting to read this because in our institution the exact opposite has happened. For years we used etomidate for the unstable ones and propofol for the stable ones as sedative of choice.

Nearly all our emergent intubations nowadays are performed under rocuronium, ketamine and usually a benzo or opioid (this based on cardiovascular profile of the pt) to counteract the dissociative state ketamine induces. Only when ketamine is contra-indicated will we use etomidate.

In recent years emergent intubations with propofol have become rare in our instution due to the hemodynamic compromise it generally causes in the critically ill. Intubations with propofol in critically ill patients in our institution is generally frowned upon. Only time I see it nowadays is when intubating a hypertensive patient (e.g. neurosurgical candidates).

Etomidate has the potential to suppress your adrenals (even after 1 dose!)---causes less endogenous catecholamines (which are necessary for some drugs, such as Ephedrine, to work.

Powerpoint on Adrenal Suppression from Etomidate: http://clinicaldepartments.musc.edu/anesthesia/intranet/education/resident%20research/files/joel%20bridgewater.pdf