Succinylcholine, SUX for short, is a neuromuscular paralytic drug. This means that it works at the junction of the nerves and muscles and causes muscular paralysis. It paralyzes all the muscles of the body, including those used for breathing. Without ventilatory support anyone who receives this drug will die from asphyxia. The bad news is that they will be wide awake while this occurs because SUX causes muscular paralysis but has no sedative effects.
In medicine, it is used as part of anesthesia. Since it causes complete muscular relaxation it makes passing the endotracheal (ET) tube much easier. This ET tube is passed through the nose or the mouth and into the trachea where a balloon is inflated to keep it in position. The tube has been used to ventilate the patient throughout the surgery.
Succinylcholine, or some similar paralytic agent, is part of the three drug cocktail used in lethal injection executions. The first is a sedative to put the person to sleep, the second is the paralytic drug that paralyzes all muscles, and the final is potassium chloride which immediately stops the heart.
Succinylcholine must be injected and it works very quickly—within seconds to a minute. It is very short acting because enzymes in the body begin to break down the drug almost immediately. This makes it tough for the crime lab. There is no Succinylcholine left to test and so testing for it will prove negative. However testing for the breakdown products, also called metabolites, of the drug has proved successful in many cases.
The ability to test for these breakdown products stemmed from the case of Carl Coppolino, one of F. Lee Bailey’s most famous cases. This case is a milestone in Forensic Toxicology.
Carl Coppolino and his wife Carmela were both physicians, who moved from New Jersey to Longboat Key, Florida. On the night of August 28, 1965, Carl called his friend Dr. Juliette Karow and told her he had found his wife dead of an apparent heart attack. Dr. Karow came to the Coppolino home, agreed with Carl’s assessment, and ultimately signed Carmela’s death certificate, stating that her death was due to a coronary thrombosis. The Sarasota County Medical Examiner also agreed so no autopsy was performed.
Slightly more than a month later, Carl married wealthy socialite Mary Gibson, which angered his neighbor Marjorie Farber. It seems that Marjorie and her husband knew the Coppolinos in New Jersey. In fact, Marjorie and Carl had been having an affair. After the death of Marjorie’s husband William and Carl’s move to Florida, she followed the Coppolinos to Florida so she could continue her relationship with Carl.
Marjorie visited her friend Dr. Karow and told her that Marjorie’s husband’s death back in New Jersey had not been the natural event everyone thought. She said that Carl, who was an anesthesiologist, had given her a syringe filled with a liquid and instructed her how to inject her husband with it. Her attempt was only partially successful and she managed to inject only a small amount of the drug into her husband. She panicked and called Carl who came over and finished off William by strangling him. Carl returned home and then Marjorie called the Coppolino’s home, saying that her husband had died of an apparent heart attack. Ironically, Carmela had gone to Marjorie’s home and as a physician had pronounced William Farber dead and signed his death certificate, stating that his death was due to coronary thrombosis.
After Marjorie’s revelations, an investigation into both deaths followed with New York Chief Medical Examiner Dr. Milton Helpern performing an autopsy on each of the victims. Attorney F. Lee Bailey managed to gain an acquittal for Carl on the death of William Farber, but the interesting case was that of Carl’s wife, Carmella. Halpern was well aware that Carl was an anesthesiologist and guessed that he might have access to many anesthetic drugs, including the muscle paralytic drug succinylcholine, which at that time was essentially impossible to find in a corpse. Dr. Halpern brought toxicologist Dr. Charles Umberger into the case. After months of research, Umberger finally managed to isolate some of the metabolites of succinylcholine, one of which was succinic acid. He then found large quantities of this acid in the brain tissues of Carmela Coppolino. Carl was convicted of second-degree murder.
There have been many other famous cases in which Succinylcholine was employed or at least suspected to have been used. Here are a couple of interesting ones: