Succinylcholine, which is the only depolarizing agent in current clinical use, has the fastest onset and shortest action duration. Its principal use is to secure the airway rapidly, and therefore it is often used in new admissions to the ICU when the time of last food intake is unknown or gastric stasis and a full stomach are suspected. Once the trachea is intubated, it is unusual to continue using succinylcholine.

A number of unwanted side-effects exist including myalgia, masseter spasm, precipitation of malignant hyperthermia, and fasciculations. The side-effect of most potential hazard to the ICU patient is an increase in the serum potassium concentration. Although this increase is only 0.5 to 1.0 mmol/l in normal patients, it is accentuated in patients with burns, muscle trauma, prolonged immobility, and spinal cord injuries. The use of succinylcholine in these patients, or in the presence of an already raised serum potassium, may precipitate a cardiac arrest.

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