Classifications: NONDEPOLARIZING SKELETAL MUSCLE RELAXANT; ACETYLCHOLINE RECEPTOR ANTAGONIST
Therapeutic: SKELETAL MUSCLE RELAXANT
ACTION & THERAPEUTIC EFFECT
Intermediate-acting nondepolarizing skeletal
muscle relaxant that inhibits neuromuscular transmission by competitively
binding with acetylcholine at receptors located on motor endplate receptors. Effective
as a skeletal muscle relaxant.
Adjunct for general anesthesia to produce
skeletal muscle relaxation during surgery.
Hypersensitivity to vecuronium.
Severe liver disease; impaired acid–base, fluid and
electrolyte balance; longterm use; severe obesity; adrenal or neuromuscular
disease (myasthenia gravis, Eaton-Lambert syndrome); patients with slow circulation
time (cardiovascular disease, old age, edematous states); obesity, pregnancy
(category C), lactation; children younger than 1 y and older than 7 wk.
Skeletal Muscle Relaxation
Adult/Child (10 y or older): IV 0.08–0.1 mg/kg initially, then after 25–40 min, 0.01–0.15 mg/kg
q12–15min or 0.001 mg/kg/min by continuous infusion for prolonged procedures
Child (1–10 y)/Infant: IV Varies greatly; may require higher initial dose
Obesity Dosage Adjustment
Note: Vecuronium is administered only by
qualified clinicians.
PREPARE: Direct: Reconstitute the 10 or 20
mg vial with 10 or 20 mL, respectively, of sterile water for injection
(supplied). Continuous: Further dilute the reconstituted solution in up
to 100 mL D5W, NS, or LR to yield 0.1–0.2 mg/mL.
ADMINISTER: Direct: Give a bolus dose over 30
sec. Continuous: Give at the required rate.
Y-site: Amphotericin B
cholesteryl complex, diazepam, etomidate, furosemide, thiopental.
- Refrigerate after reconstitution below 30° C (86° F), unless
otherwise directed. Discard solution after 24 h.
Body as a Whole: Skeletal muscle weakness, malignant hyperthermia. Respiratory: Respiratory
depression.
Drug: GENERAL ANESTHETICS increase
neuromuscular blockade and duration of action; AMINOGLYCOSIDES, bacitracin,
polymyxin B, clindamycin, lidocaine, parenteral magnesium, quinidine, quinine,
trimethaphan, verapamil increase neuromuscular blockade; DIURETICS may increase
or decrease neuromuscular blockade; lithium prolongs duration of
neuromuscular blockade; NARCOTIC ANALGESICS increase possibility of additive respiratory
depression; succinylcholine increases onset and depth of neuromuscular
blockade; phenytoin may cause resistance to or reversal of neuromuscular
blockade.
Onset: Less than 1 min. Peak:
3–5 min. Duration: 25–40 min. Distribution: Well distributed
to tissues and extracellular fluids; crosses placenta; distribution into breast
milk unknown. Metabolism: Rapid nonenzymatic degradation in bloodstream.
Elimination: 30–35% in urine, 30–35% in bile. Half-Life: 30–80
min.
Assessment & Drug Effects
- Use peripheral nerve stimulator during and following drug
administration to avoid risk of overdosage and to identify residual paralysis during
recovery period. This is especially indicated when cautious use of drug is
specified.
- Monitor vital signs at least q15min until stable, then q30min for the
next 2 h. Also monitor airway patency until assured that patient has fully
recovered from drug effects. Note rate, depth, and pattern of respirations.
Obese patients and patients with myasthenia gravis or other neuromuscular disease
may have ventilation problems.
- Evaluate patients for recovery from neuromuscular blocking
(curarelike) effects as evidenced by ability to breathe naturally or take deep breaths
and cough, to keep eyes open, and to lift head keeping mouth closed and by
adequacy of hand grip strength. Notify prescriber if recovery is delayed.
- Note: Recovery time may be delayed in patients with cardiovascular
disease, edematous states, and in older adults.
- Montior lab tests: Baseline serum electrolytes, acid–base balance,
LFTs, and kidney functions.
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