Adult Dosing
Endotracheal intubation
- 0.06-0.1 mg/kg IV; skeletal muscle relaxation usually occurs within 2-3 minutes
To provide skeletal muscle relaxation during surgery or mechanical ventilation
- 0.04-0.1 mg/kg IV; skeletal muscle relaxation usually occurs within 2-3 minutes
- Incremental doses of 0.01 mg/kg may be administered at 25- to 60-minute intervals
- A dose of 0.015 mg/kg may be used to maintain relaxation for controlled respiration
Pediatric Dosing
Endotracheal intubation
- <1 month: Use a test dose of 0.02 mg/kg IV to measure responsiveness
- >1 month: 0.06-0.1 mg/kg IV; skeletal muscle relaxation usually occurs within 2-3 minutes
To provide skeletal muscle relaxation during surgery or mechanical ventilation
- <1 month: Use a test dose of 0.02 mg/kg IV to measure responsiveness
- >1 month: 0.04-0.1 mg/kg IV; skeletal muscle relaxation usually occurs within 2-3 minutes
- Incremental doses of 0.01 mg/kg may be administered at 25- to 60-minute intervals
- A dose of 0.015 mg/kg may be used to maintain relaxation for controlled respiration
[Outline]
- Pancuronium bromide injection should be administered in carefully adjusted doses under the supervision of experienced clinicians, and when facilities for intubation, artificial respiration, oxygen therapy, and reversal agents are immediately available
- A small test dose along with a peripheral nerve stimulator should be used to monitor responsiveness in patients with myasthenia gravis or the myasthenic (Eaton-Lambert) syndrome
- Appropriate monitoring, such as use of a peripheral nerve stimulator, to assess the neuromuscular blocking effect, may preclude excessive dosing and assist in evaluation of recovery
- An increased incidence of kernicterus in small preterm infants, and toxic reactions such as hypotension and metabolic acidosis in neonates have occurred due to excessive amounts of benzyl alcohol; if patients require more than the recommended dose of drug, the practitioner should consider the daily metabolic load of benzyl alcohol
- Conditions such as cardiovascular disease, old age, and edematous states having slow circulation time increases the volume of distribution, which may produce delayed onset of action; avoid increasing doses in these conditions
- When used in patients with renal failure, hepatic, or biliary tract disease, the possibility of slower onset, higher total dosage and prolongation of neuromuscular blockage should be considered, as they have doubled elimination half-life, reduced plasma clearance, and increased volume of distribution
- Prolonged use to facilitate mechanical ventilation in the intensive care unit may cause prolonged paralysis and skeletal muscle weakness. Also, long-term use in patients immobilized for extended periods may frequently develop symptoms consistent with disuse muscle atrophy. Therefore, benefits-to-risk ratio of neuromuscular blockade should be considered in patients requiring long-term mechanical ventilation
- Clinically significant methemoglobinemia have been reported rarely in premature neonates receiving pancuronium in combination with fentanyl and atropine for emergency anesthesia and surgery
- Patients with severe obesity or neuromuscular disease may require special attention as they may pose airway and ventilatory problems
- Pancuronium has no effect on consciousness, pain threshold, or cerebration; administration should be accompanied by adequate sedation or anesthesia
- Severe, life-threatening anaphylactic reactions to pancuronium have been reported; institute appropriate emergency treatment. Take precautions in individuals who have had previous anaphylactic reactions to other neuromuscular blocking agents since allergic cross-reactivity has been reported
Cautions: Use cautiously in
- Neuromuscular disease
- Pulmonary disease
- Impaired circulation
- Anticonvulsant use
- Endocrine disease
- Acid-base disorder
- Dehydration
- Electrolyte abnormalities
- Severe obesity
- Severe hypothermia
- Febrile illness
- Carcinomatosis
- Major trauma or burns
- Cerebral palsy
- Hemiparesis or paraparesis
- Cachetic or debilitated patients
- Neonates
Pregnancy Category:C
Breastfeeding: Safety undetermined; avoid use.
