Suxethonium chloride

Suxethonium (trade name: "Brevidil-E") is a depolarising muscle relaxant which was presented as a dry powder in an ampoule. This was re-constituted with sterile water prior to use. It was once available in Australia (and may still be but I haven't seen it since the early 1980s).

Advantages

It had some advantages over suxamethonium:
# Less K⁺ release (eg [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=791307&query_hl=1&itool=pubmed_docsum see Day BJA 1976] )
# Possibly less muscle pain after use
# Storage does not require refrigeration

This last advantage was what kept it in occasional use.

Previous use

In the UK, it was used by the "Obstetric Flying Squads" which used to go to patient's homes and resuscitate & retrieve mothers during major obstetric complications (mostly major haemorrhage) during home births.

In Australia, it was used in "Resuscitation drugs packs" in hospitals. These packs were sealed boxes containing all the drugs required for an in-hospital resuscitation. They were prepared by the hospital pharmacy and because these were sealed (usually just sticky tape) the drug contents were guaranteed to be there for use in a cardiac arrest. These packs contained ampoules of powdered suxethonium so a relaxant was available to facilitate intubation. Suxamethonium could not be used in these packs because of the requirement for refrigeration. This was certainly an issue in Queensland as it could be quite warm and hospitals wards were generally not air-conditioned in the past.

It can still be used where the storage issue is a concern (eg by the military, rural locations, 3rd world countries) but I have no details on this. The most recent reference to it in Medline is 1976), but it is occasionally mentioned in passing in other journals (eg [http://www.kumj.com.np/past/Vol1/issue1/vol1_18.pdf Kathmandu University Medical Journal 2003; 1: 60-65)] . Given the advantage of storage in such situations it is surprising that it is not available).