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Moradi M, Hashemian MA, Douhandeh E, Peysokhan M, Hashemian AH, Faramarzi A

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Oct 2007;323(1):138-146

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Birnkrant et al 2018): Burns or major trauma (2472 hours post-injury) Neuromuscular disorders Myopathies Acute narrow-angle glaucoma or penetrating eye injury Side Effects Malignant hyperthermia (rare but fatal risk) Hyperkalemia (can be life-threatening) Risk of: Cardiac arrest Rhabdomyolysis Cardiac arrhythmias (bradycardia or tachycardia) Muscle pain (due to fasciculations) Increased intragastric pressure aspiration risk Increased intraocular pressure (contraindicated in glaucoma) Pharmacokinetics Routes: IV or IM Rapid metabolism by plasma pseudocholinesterase Not metabolized by acetylcholinesterase Key Parameters: Onset: 3060 seconds Duration: 610 minutes Half-life: 35 minutes Notes: Phase II block recovery may last 30 minutes or longer Duration depends on: Rate of receptor dissociation Plasma enzyme activity Drug Interactions Increase Duration of Action: Cholinesterase inhibitors (e.g., neostigmine , pyridostigmine) Administration of neostigmine & pyridostigmine to patients to reverse non-depolarizing skeletal muscle blockade has been shown to cause profound reductions of plasma pseudocholinesterase activity for several hours duration (Mirakhur et al, 1982), an effect that can mechanistically account for the observed prolongation of succinylcholine effect by these cholinesterase inhibitors (Sunew & Hicks, 1978

In one study, 18 sessions of remote neurofeedback (administered over the internet) was reported to decrease both the time needed to fall asleep as well as increase total sleep time [43]