ACCS Practice Exam 2025 – Complete Test Preparation Guide

Succinylcholine is least appropriate for lengthy procedures due to its short duration of action and unique pharmacological properties. This neuromuscular blocker is rapidly hydrolyzed by plasma cholinesterase, leading to a quick onset and a short duration of paralysis, typically around 5-10 minutes. During prolonged transport, if a situation arises where sustained paralysis is necessary, the transient effects of succinylcholine could lead to a return of muscle function before the procedure is completed, which could complicate patient management.

In contrast, other paralytics such as rocuronium, atracurium, and vecuronium offer longer durations of action, providing a more stable and sustained period of paralysis which is preferable in the context of lengthy procedures. Additionally, atracurium's metabolism through non-specific plasma esterases and tissue esterases means it remains effective in cases of prolonged transport and varying patient conditions without the risk of spontaneous recovery early in the procedure. Vecuronium also provides a longer effect but can be reversed with a reversal agent, establishing control over the duration of paralysis.

Thus, succinylcholine is not the optimal choice for such scenarios, making it the least appropriate option among those listed.