Tracheal intubation, surgical relaxation, optimizing mechanical ventilation conditions, patients with ARDS
|Routes of administration||
|Mechanism of action||
Nicotinic acetylcholine antagonism
|Duration of action||
Liver, bile, and renal
|Physical and chemical data|
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.
- 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.
- Known hypersensitivity
- Prolonged duration of action in patients with cholestasis or cirrhosis
- Use in patients with renal failure
- 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.
- 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
- 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
- First non-depolarizing neuromuscular blocking agent with an intermediate duration of action to be introduced into clinical practice
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
- Lien, Cynthia A.; Eikermann, Matthias (2013), "Neuromuscular Blockers and Reversal Drugs", Pharmacology and Physiology for Anesthesia, Elsevier, pp. 325–348, retrieved 2023-01-05
- Nina., Gupta, Anita. Singh-Radcliff, (2013). Pharmacology in anesthesia practice. Oxford University Press. ISBN 978-0-19-978267-3. OCLC 940638246.CS1 maint: extra punctuation (link)