PANCURONIUM BROMIDE

PANCURONIUM BROMIDE
(pan-kyoo-roe'nee-um)
Classifications: skeletal muscle relaxant, nondepolarizing;
Therapeutic: skeletal muscle relaxant, nondepolarizing

Prototype: Atracurium
Pregnancy Category: C

Availability

1 mg/mL, 2 mg/mL injection

Action

Synthetic curariform nondepolarizing neuromuscular blocking agent that produces little or no histamine release or ganglionic blockade and thus does not cause bronchospasm or hypotension. Produces skeletal muscle relaxation or paralysis by competing with acetylcholine at cholinergic receptor sites on skeletal muscle endplate and thus blocks nerve impulse transmission.

Therapeutic Effect

Induces skeletal muscle relaxation or paralysis.

Uses

Adjunct to anesthesia to induce skeletal muscle relaxation. Also to facilitate management of patients undergoing mechanical ventilation.

Contraindications

Hypersensitivity to the drug or bromides; tachycardia; pregnancy (category C).

Cautious Use

Debilitated patients; dehydration; myasthenia gravis; neuromuscular disease; pulmonary, liver, or kidney disease; fluid or electrolyte imbalance; lactation.

Route & Dosage

Skeletal Muscle Relaxation
Adult/Child: IV 0.04–0.1 mg/kg initial dose, may give additional doses of 0.01 mg/kg at 30–60 min intervals
Neonate: IV 0.02 mg/kg test dose, then 0.03 mg/kg

Obesity
Use IBW.

Renal Impairment
Clcr 10–50 mL/min: use 50% of dose; <10 mL/min: do not use

Administration

Intravenous
  • Plastic syringe may be used for administration, but drug may adsorb to plastic with prolonged storage.
  • Use a test dose of 0.02 mg/kg in infants ≥1 mo.

PREPARE: Direct: Give undiluted.  

ADMINISTER: Direct: Give over 30–90 sec.  

INCOMPATIBILITIES Solution/additive: Furosemide.

  • Refrigerate at 2°–8° C (36°–46° F). Do not freeze.

Adverse Effects (≥1%)

CV: Increased pulse rate and BP, ventricular extrasystoles. Skin: Transient acneiform rash, burning sensation along course of vein. Body as a Whole: Salivation, skeletal muscle weakness, respiratory depression.

Diagnostic Test Interference

Pancuronium may decrease serum cholinesterase concentrations.

Interactions

Drug: general anesthetics increase neuromuscular blocking 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 possibly add to respiratory depression; succinylcholine increases onset and depth of neuromuscular blockade; phenytoin may cause resistance to or reversal of neuromuscular blockade.

Pharmacokinetics

Onset: 30–45 sec. Peak: 2–3 min. Duration: 60 min. Distribution: Well distributed to tissues and extracellular fluids; crosses placenta in small amounts. Metabolism: Small amount in liver. Elimination: Primarily in urine. Half-Life: 2 h.

Nursing Implications

Assessment & Drug Effects

  • Assess cardiovascular and respiratory status continuously.
  • Observe patient closely for residual muscle weakness and signs of respiratory distress during recovery period. Monitor BP and vital signs. Peripheral nerve stimulator may be used to assess the effects of pancuronium and to monitor restoration of neuromuscular function.
  • Note: Consciousness is not affected by pancuronium. Patient will be awake and alert but unable to speak.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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