Vecuronium
Mechanism :
It is a muscle-relaxing drug and acts by preventing the binding of acetylcholine to the muscle end plate, which is a chemical substance that helps in muscle contraction. Vecuronium is a nondepolarizing neuromuscular blocking agent. It acts by competing for cholinergic receptors at the motor end-plate. This action is antagonized by acetylcholinesterase inhibitors, such as neostigmine and edrophonium. It is the drug of choice in patients with renal impairment as it is excreted by the biliary system.
Indication :
Contraindications :
Contraindicated in patients known to have hypersensitivity to vecuronium bromide.
Dosing :
<5 month:
Initially, 10-20 mcg/kg IV, increased if necessary according to response.
>5 month:
Initially, 80-100 mcg/kg IV single dose.
Alternatively, 30-50 mcg/kg IV after clinical recovery from neuromuscular blockade of
suxamethonium.
As an adjunct to general anaesthesia in children 1-10 years old:
0.1 mg/kg IV; repeat hourly as and when needed; OR
Continuous Infusion: 0.05-0.07 mg/kg/hour IV.
Adverse Effect :
Very few side effects reported. Vecuronium has only a weak capacity for inducing local histamine release. Respiratory insufficiency, alkalosis, hypotension.
Interaction :
Aminoglycosides, Metronidazole, Polymyxins, Suxamethonium, Nifedipine, Verapamil, Propranolol, Procainamide, Quinidine, Lithium and Parenteral Magnesium, high doses of Thiopental, Ketamine, Fentanyl, Beta-Blockers and Diuretics: Enhanced effect.
Corticosteroids, Phenytoin and Carbamazepine: Decreased effect.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in normal renal function |
| HD | Unlikely to be dialysed. Dose as in normal renal function |
| HDF/High flux | Unknown dialysability. Dose as in normal renal function |
| CAV/VVHD | Unknown dialysability. Dose as in normal renal function |
Hepatic Dose :
Dose reduction may be needed, as reduced hepatic function would reduce clearance of the drug and increase the duration of action.