Evaluating Degradation with Fragment Formation of Prehospital Succinylcholine by Mass Spectrometry

Authors

  • Mark A. Merlin DO, EMT-P,

    1. From the Department of Emergency Medicine (MAM, AMB) and the Department of Medical Education (CA), University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, NJ; the Environmental and Occupational Health Science Institute (HY, BB), a joint institute of Rutgers, The State University of New Jersey and the University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; and the Department of Biostatistics (PO), School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ.
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  • Andreia Marques-Baptista MD,

    1. From the Department of Emergency Medicine (MAM, AMB) and the Department of Medical Education (CA), University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, NJ; the Environmental and Occupational Health Science Institute (HY, BB), a joint institute of Rutgers, The State University of New Jersey and the University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; and the Department of Biostatistics (PO), School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ.
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  • Hilly Yang PhD,

    1. From the Department of Emergency Medicine (MAM, AMB) and the Department of Medical Education (CA), University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, NJ; the Environmental and Occupational Health Science Institute (HY, BB), a joint institute of Rutgers, The State University of New Jersey and the University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; and the Department of Biostatistics (PO), School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ.
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  • Pamela Ohman-Strickland PhD,

    1. From the Department of Emergency Medicine (MAM, AMB) and the Department of Medical Education (CA), University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, NJ; the Environmental and Occupational Health Science Institute (HY, BB), a joint institute of Rutgers, The State University of New Jersey and the University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; and the Department of Biostatistics (PO), School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ.
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  • Christopher Aquina,

    1. From the Department of Emergency Medicine (MAM, AMB) and the Department of Medical Education (CA), University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, NJ; the Environmental and Occupational Health Science Institute (HY, BB), a joint institute of Rutgers, The State University of New Jersey and the University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; and the Department of Biostatistics (PO), School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ.
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  • Brian Buckley PhD

    1. From the Department of Emergency Medicine (MAM, AMB) and the Department of Medical Education (CA), University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, NJ; the Environmental and Occupational Health Science Institute (HY, BB), a joint institute of Rutgers, The State University of New Jersey and the University of Medicine and Dentistry of New Jersey, New Brunswick, NJ; and the Department of Biostatistics (PO), School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ.
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  • Presented at the Society for Academic Emergency Medicine regional meeting, Newark, DE, 2009; to be presented at the North American Association of Clinical Toxicologists meeting, San Antonio, TX, 2009.

  • This study received no grants or financial support. No conflict of interest exists or copyright constraints with any author.

Address for correspondenceand reprints: Mark A. Merlin, DO; e-mail: merlinma@umdnj.edu.

Abstract

Objectives:  Pharmaceutical manufacturers recommend refrigerating succinylcholine at a temperature range of 2–8°C. With widespread use of prehospital succinylcholine on ambulances without refrigeration, it is important to understand the stability of this drug. Using mass spectrometry, this study investigated the degradation of the succinylcholine compound before and after its exposure to ambulance cabin temperatures, while removing light exposure. A 10% degradation threshold was set as not appropriate for human use, in accordance with U.S. Food and Drug Administration guidelines.

Methods:  The study used 17 vials of succinylcholine sealed with duct tape in light-resistant bags. The bags were placed in climate controlled compartments in two ambulances: one stationed in a garage and the other stationed outdoors. Mass spectrometry analysis was used to examine drug degradation at Time 0, the 14th day of the first month, and monthly from Time 0 to 7 months.

Results:  The degradation products of succinyl monocholine (SMC) and choline are already present at Day 0. Ten percent degradation was achieved at approximately 90 days into the experiment. Temperature in the ambulance climate controlled compartment was 70°F, with a range from 56 to 89°F during the 6-month time period.

Conclusions:  Identifiable breakdown fragments of succinylcholine have been identified using mass spectrometry with fresh drug upon receipt from the manufacturer. Ten percent degradation was not observed until approximately 90 days after being placed on ambulances. Temperature variations did not significantly contribute to degradation of succinylcholine, and it is safe for injection until approximately 90 days in similar climates.

ACADEMIC EMERGENCY MEDICINE 2010; 17:631–637 © 2010 by the Society for Academic Emergency Medicine

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