Vecuronium

Vecuronium

Trade names	Norcuron
Clinical data
Drug class	Neuromuscular blocker
Uses	Tracheal intubation, surgical relaxation, optimizing mechanical ventilation conditions, patients with ARDS
Contraindications	Known hypersensitivity
Routes of administration	Intravenous
Dosage
Pharmacodynamics
Mechanism of action	Nicotinic acetylcholine antagonism
Adverse effects	Anaphylactic reaction
Pharmacokinetics
Duration of action	40
Metabolism	Liver, bile, and renal
Physical and chemical data
Article quality
Editor rating	Unrated
User likes	0

Vecuronium is a steroidal intermediate acting non-depolarizing neuromuscular blocking agent used for tracheal intubation and surgical relaxation in patients. It is also used to provide paralysis in patients with acute respiratory distress syndrome in the intensive care unit.

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
• Use 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
• Muscle weakness or myopathy due to persistent failure of neuromuscular transmission and immobilization-induced atrophy of diaphragm
• Posttraummatic stress syndrome from awareness during paralysis if sedation is not used adequately.
• Impairment of ventilation-perfusion distribution and decreased right ventricular end-diastolic volume due to abolishment of spontaneous breathing.
• Incomplete reversal of neuromuscular blocking agent leading to respiratory depression

Pharmacokinetics

• Duration of action after 1 x ED₉₅ is 40 minutes

Chemistry and formulation

• 2-desmethyl derivative of pancuronium
• Supplied as crystalline particles that may be reconstituted with IV fluid

History

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

References

Lien, Cynthia A.; Eikermann, Matthias (2013), "Neuromuscular Blockers and Reversal Drugs", Pharmacology and Physiology for Anesthesia, Elsevier, pp. 325–348, retrieved 2023-01-05

Anita Gupta, Nina Singh-Radcliff. Pharmacology in Anesthesia Practice. Oxford University Press; 2013. Accessed January 5, 2023. https://search-ebscohost-com.laneproxy.stanford.edu/login.aspx?direct=true&db=nlebk&AN=603930&site=ehost-live