숙사메토늄

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금기

• Patients with pre-existing hyperkalemia
• Glaucoma or penetrating eye injuries
• Severe liver disease
• Patients with known atypical plasma pseudocholinesterase
• Conscious patients (must be fully anesthetized)

이상반응

• Muscle fasciculations
• Hyperkalemia
• Bradycardia or arrhythmias
• Malignant hyperthermia
• Increased intraocular pressure
• Increased intragastric pressure
• Prolonged apnea

약물 상호작용

• Organophosphates · Inhibit pseudocholinesterase, leading to significantly prolonged neuromuscular blockade · major
• Carbamates · Inhibit pseudocholinesterase, leading to significantly prolonged neuromuscular blockade · major
• Aminoglycosides · May enhance or prolong neuromuscular blockade · moderate
• Volatile anesthetics · Enhanced neuromuscular blockade and increased risk of malignant hyperthermia · major

모니터링

• Heart rate and rhythm (ECG)
• Blood pressure
• Oxygen saturation (SpO2)
• End-tidal CO2 (Capnography)
• Body temperature (monitor for malignant hyperthermia)
• Peripheral nerve stimulation (Train-of-Four) to assess blockade depth and recovery

과용량

Overdose results in prolonged neuromuscular blockade and extended apnea. **Treatment is strictly supportive** with continuous mechanical ventilation and maintenance of anesthesia until the drug is fully metabolized and spontaneous respiration returns. **There is no specific pharmacological reversal agent** for depolarizing neuromuscular blockers.