Succinylcholine is given systemically because the molecule is charged and does not easily cross membranes. It is rapidly hydrolyzed by plasma cholinesterase to succinyl-monocholine, which is pharmacologically inactive. Because plasma cholinesterase is synthesized in the liver, neuromuscular block may be prolonged in patients with liver disease. About 10% of succinylcholine is excreted unchanged in the urine. The response to succinylcholine may also be prolonged in individuals with a genetic defect leading to atypical plasma cholinesterase (homozygous incidence of about 1 in 2,500). In this case, the enzyme has a decreased affinity for substrates such as succinylcholine that can be measured by the dibucaine test.
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