Vecuronium

Vecuronium

Clinical data
Drug class	Neuromuscular blocker
Routes of administration	Intravenous
Dosage
Vecuronium Standard 0.1 mg/kg IV (Ideal body weight) Rapid sequence 0.15-0.2 mg/kg IV (Ideal body weight) Maintenance (bolus) 0.01-0.015 mg/kg IV q20-40m (Ideal body weight) Maintenance (infusion) 0.05-0.07 mg/kg/hr IV (Ideal body weight) More information about this dose Weight kglbg Height cmminft Age yrmowk SexFM Indication  Indication: Neuromuscular blockade Route  Route: Intravenous For rapid sequence, can give priming dose of 0.01 mg/kg three minutes before induction to reduce onset of paralysis to 75 to 90 seconds. Ramzy M, McAllister RK. Vecuronium. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493143/ Smith CE, Kovach B, Polk JD, Hagen JF, Fallon WF Jr. Prehospital tracheal intubating conditions during rapid sequence intubation: rocuronium versus vecuronium. Air Med J. 2002 Jan-Feb;21(1):26-32. doi: 10.1067/mmj.2002.121713. PMID: 11805764. Baumgarten RK, Carter CE, Reynolds WJ, Brown JL, DeVera HV. Priming with nondepolarizing relaxants for rapid tracheal intubation: a double-blind evaluation. Can J Anaesth. 1988 Jan;35(1):5-11. doi: 10.1007/BF03010536. PMID: 2894903. Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010 Dec;105 Suppl 1:i16-23. doi: 10.1093/bja/aeq312. PMID: 21148651.
Pharmacodynamics
Mechanism of action	Nicotinic acetylcholine antagonism
Pharmacokinetics
Physical and chemical data
Article quality
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Vecuronium is an steroidal intermediate acting non-depolarizing neuromuscular blocking agent

Uses

• Optimizing tracheal intubation condition
  • Abduction of vocal cords
  • Opening of mouth
  • Reduction in coughing and gagging
• Provide surgical relaxation
• Optimizing mechanical ventilation conditions
  • Reduction in bucking/coughing
  • Reduction in breath stacking

• Provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit via continuous infusion early in the course of ARDS for patients with a PaO2/FiO2 less than 150. The proposed mechanism of the beneficial effect is possibly by lowering trans-pulmonary pressure reducing barotrauma.

Contraindications

Absolute contraindications

Known hypersensitivity

Precautions

Prolonged duration of action in patients with cholestasis or cirrhosis

Dose requirement can be unpredictable in patients with renal failure

Pharmacology

Pharmacodynamics

Primarily eliminated via hepatic metabolism: 30-40%

Elimination via bile: 40%

Elimination via renal: 20-30%

3-desacetylvecuronium, 17-desacetylvecuronium and 3,17-desacetylvecuronium metabolites have neuromuscular blocking activity

Mechanism of action

Competitive antagonism of acetylcholine at the post junctional receptors preventing depolarization of the muscle preventing any movement. Only one molecule of the neuromuscular blocker is needed to prevent activation of the receptor as it competes with acetylcholine at the two binding sites.

Adverse effects

• Anaphylactic reaction

Pharmacokinetics

Duration of action of 40 minutes

Chemistry and formulation

2-desmethyl derivative of pancuronium

History

First non-depolarizing neuromuscular blocking agent with an intermediate duration of action to be introduced into clinical practice