A 30-year-old man with 40% total body surface area burns is intubated on post-burn day 3 for airway edema. Which neuromuscular blocking agent is contraindicated during rapid sequence induction due to risk of life-threatening hyperkalemia?
- A Rocuronium
- B Succinylcholine ✓
- C Vecuronium
- D Cisatracurium
Correct answer: B. Succinylcholine
Explanation
Succinylcholine is contraindicated in burns beyond 24 hours due to extrajunctional proliferation of nicotinic acetylcholine receptors. Stimulation causes massive potassium release, leading to hyperkalemic cardiac arrest. Non-depolarizing agents (rocuronium, vecuronium, cisatracurium) are safe. The risk persists for up to 2 years post-burn. Rocuronium with sugammadex is the preferred rapid sequence induction combination in burn patients. Succinylcholine remains acceptable in the first 24 hours.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.