琥珀膽鹼
琥珀膽鹼（Succinylcholine）是一種超短效去極化神經肌肉阻斷劑。主要用於獸醫學中，以促進快速氣管插管並在手術期間提供骨骼肌鬆弛。 > **臨床提示：** 由於它是去極化劑，使用前常會出現短暫的肌肉顫動。它**不具備鎮痛或鎮靜作用**；病患必須完全麻醉並接受機械通氣。
作用機制: Competitively binds to the **nicotinic acetylcholine receptor** at the neuromuscular junction. The persistent depolarization prevents the transmission of further action potentials → resulting in flaccid muscle relaxation.
給藥途徑
禁忌症
- 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)
不良反應
- Muscle fasciculations
- Hyperkalemia
- Bradycardia or arrhythmias
- Malignant hyperthermia
- Increased intraocular pressure
- Increased intragastric pressure
- Prolonged apnea
藥物相互作用
- 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
監測
- 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
過量
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.
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