Succinylcholine is a depolarizing neuromuscular junction blocker used to cause paralysis during anesthesia. It acts by agonizing nicotinic acetylcholine receptors, which in turn causes continuous depolarization at the motor end plate. Initially, phase I block causes total depolarization and blockage of muscle contractions, which can be visualized as equal reductions on train of four stimulation. With continued administration, this transitions to phase II block, where the cell becomes repolarized but desensitized, which is visualized as progressive reduction on train of four stimulation. During phase II block, neostigmine can be administered to reverse paralysis. Don't forget the adverse effects of succinylcholine, which include hyperkalemia and dangerously, malignant hyperthermia.


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