Source: Marketing Authorisation Holder Revision Year: 2022
Ethicholine Injection is indicated for the production of skeletal muscle relaxation during operative and manipulative procedures, and in conjunction with electroshock therapy. The short duration of action of the drug is ideally suited for procedures requiring only brief relaxation such as endotracheal intubation, endoscopic examinations, orthopaedic manipulations, short surgical procedures such as tonsillectomies and electroshock therapy. The drug is also indicated to provide muscular relaxation during surgical techniques of longer duration.
Ethicholine Injection is usually administered by the intravenous route.
Ethicholine Injection is given by intravenous injection in single doses ranging from 0.4 mL to 2 mL according to the depth and duration of relaxation required. For adults, the average dose for intubation is from 1 mL to 1.6 mL; for electroconvulsive therapy 0.8 mL to 1.5 mL and for manipulations 1.6 mL.
The dose of Ethicholine Injection is dependent upon the degree of muscular relaxation required and the response of individual patients. A dose of 1 mg/kg will produce muscular relaxation in about 60 seconds and has a duration of action of about 10 minutes.
Longer periods of relaxation for major surgical operations may be produced if Ethicholine Injection is given by repeated intermittent injection or by continuous intravenous infusion. A 1 mg/mL to 2 mg/mL solution may be prepared by the addition of Ethicholine Injection to sodium chloride 0.9% injection or to dextrose 5% injection immediately before use. The rate of infusion ranges from 2 to 6 mg of suxamethonium (40 to 120 drops of the 0.1% dilution and 20-60 drops of the 0.2% dilution of Ethicholine Injection per minute; the average being 3 mg (60 drops of the 0.1% dilution and 30 drops of the 0.2% dilution) per minute.
For infants and in other patients in whom a suitable vein is not accessible, the drug may be administered by deep intramuscular injection, preferably high into the deltoid muscle.
Up to 2.5 mg/kg body weight, but no more than 150 mg total dose should be given to adults and children by the IM route.
Note: an initial test dose of 0.1 mg/kg may be used to determine the sensitivity of the patient to Ethicholine Injection and individual recovery time.
To avoid distress to the patient Ethicholine Injection should not be administered before unconsciousness has been induced and should always be accompanied by assisted respiration.
After administration of Ethicholine Injection, the lungs must be inflated for about one minute, with either pure oxygen or a 50% mixture of oxygen and nitrous oxide, to allow time for the full effect of the relaxant to develop before laryngoscopy, intubation or administration of a local anaesthetic.
Inflation of the lungs must be continued after intubation until spontaneous respiration returns.
Apnoea and prolonged muscle paralysis are the main and most serious effects of overdosage.
It is essential to maintain the airway and adequate ventilation until spontaneous respiration occurs. Assisted respiration sufficient for full oxygenation, yet avoiding excessive elimination of carbon dioxide, should be maintained until paralysis passes off. This should be combined with light narcosis, e.g., with nitrous oxide-oxygen mixture.
If the blockade is a Phase II block, which is indicated by a fading of responses to successive peripheral nerve stimulation, neostigmine may be used to reverse the block.
The use of neostigmine to reverse a Phase II block is a decision which depends on the subject and the experience and judgement of the doctor. If neostigmine is used, its administration should be preceded by that of atropine to protect against any muscarinic effects which may otherwise be elicited.
Store at 2°C-8°C.
Refrigerate. Do not freeze. Protect from light.
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