vecuronium

High Alert

Induction of skeletal muscle paralysis and facilitation of intubation after induction of anesthesia in surgical procedures.
Facilitation of compliance during mechanical ventilation.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Hypersensitivity to bromides;

Use Cautiously in:

Dehydration or electrolyte abnormalities (should be corrected);
Fractures or muscle spasm;
Hyperthermia (↑ duration/intensity of paralysis);
Significant hepatic impairment;
Shock;
Extensive burns (may be more resistant to effects);
Low plasma pseudocholinesterase levels (may be seen in association with anemia, dehydration, cholinesterase inhibitors/insecticides, severe liver disease, pregnancy, or hereditary predisposition);
Obese patients ;
OB: Safety not established (use only if benefit outweighs potential risk to fetus)
Pedi: Children <7 wk (safety and effectiveness not established)

Exercise Extreme Caution in:

Neuromuscular diseases such as myasthenia gravis (small test dose may be used to assess response).

Adv. Reactions/Side Effects ⬆ ⬇

Derm: rash

Resp: bronchospasm

Misc: ANAPHYLAXISALLERGIC REACTIONS INCLUDING

Interactions ⬆ ⬇

Drug-drug:

Intensity and duration of paralysis may be prolonged by pretreatment with succinylcholine, general anesthesia (inhalation), aminoglycosides, vancomycin, tetracyclines, polymyxin B, colistin, clindamycin, lidocaine, and other local anesthetics, lithium, quinidine, procainamide, beta-adrenergic blocking agents, potassium-losing diuretics, or magnesium.
Higher infusion rates may be required and duration of action may be shortened in patients receiving long-term carbamazepine or phenytoin.

Availability ⬆ ⬇

(Generic available)

Powder for injection: 10 mg/vial; 20 mg/vial

Route/Dosage ⬆ ⬇

IV (Adults and Children >10 yr): Intubation: 0.08–0.1 mg/kg (0.06–0.085 mg/kg if given after steady-state anesthesia achieved or 0.04–0.06 mg/kg after succinylcholine-assisted intubation and anesthesia; wait for disappearance of succinylcholine effects; or 0.05–0.06 mg/kg during balanced anesthesia); Maintenance dose: 0.01–0.015 mg/kg 25–40 min after initial dose, then q 12–15 min as needed; Continuous infusion: 0.8–1.2 mcg/kg/min.
IV (Children 1–10 yr): 0.1 mg/kg q 1 hr as needed.
IV (Infants 7 wk– 1 yr): 0.1 mg/kg q 1 hr as needed or as a continuous infusion of 1–1.5 mcg/kg/min.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Prevents neuromuscular transmission by blocking the effect of acetylcholine at the myoneural junction. Has no analgesic or anxiolytic properties

Therapeutic effects:

Skeletal muscle paralysis.

Classifications ⬆ ⬇

Therapeutic Classification: neuromuscular blocking agents-nondepolarizing

Pharmacokinetics ⬆ ⬇

Absorption: Following IV administration, absorption is essentially complete.

Distribution: Rapidly distributes in extracellular fluid; minimal penetration of the CNS.

Metabolism/Excretion: Some metabolism by the liver (20%), with conversion to at least one active metabolite; 35% excreted unchanged by the kidneys

Half-Life: Infants: 65 min; Children: 41 min; Adults: 65–75 min (↓ near term in pregnant patients, ↑ in hepatic impairment).

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IV	1–3 min	3–5 min	30–40 min

Patient/Family Teaching ⬆ ⬇

Explain all procedures to patient receiving vecuronium therapy without general anesthesia, because consciousness is not affected by vecuronium alone.
Reassure patient that communication abilities will return as medication wears off.

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Indications ⬇