VECURONIUM

VECURONIUM (vek-yoo-roe'nee-um) Classifications: acetylcholine antagonist; nondepolarizing skeletal muscle relaxant; Therapeutic: skeletal muscle relaxant, nondepolarizing Prototype: Atracurium Pregnancy Category: C

Availability

4 mg, 10 mg, 20 mg vials

Action

Intermediate-acting nondepolarizing skeletal muscle relaxant structurally similar to pancuronium. Inhibits neuromuscular transmission by competitively binding with acetylcholine to motor endplate receptors.

Therapeutic Effect

Inhibits neuromuscular transmission by competitively binding with acetylcholine to motor endplate receptors resulting in skeletal muscular relaxation.

Uses

Adjunct for general anesthesia to produce skeletal muscle relaxation during surgery. Especially useful for patients with severe kidney disease, limited cardiac reserve, and history of asthma or allergy. Also to facilitate endotracheal intubation.

Unlabeled Uses

Continuous infusion for facilitation of mechanical ventilation.

Contraindications

Hypersensitivity to bromide; pregnancy (category C).

Cautious Use

Severe liver disease; impaired acid–base, fluid and electrolyte balance; severe obesity; adrenal or neuromuscular disease (myasthenia gravis, Eaton-Lambert syndrome); patients with slow circulation time (cardiovascular disease, old age, edematous states); malignant hyperthermia; lactation.

Route & Dosage

Skeletal Muscle Relaxation Adult/Child (≥1 y): IV 0.04–0.1 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 Infant: IV 0.08–0.1 mg/kg, then 0.05–0.1 mg/kg q1h prn Neonate: IV 0.1 mg/kg, followed by 0.03–0.15 mg/kg q1–2h prn Obesity Dose based on IBW.

Administration

Note: Vecuronium is administered only by qualified clinicians.

Intravenous PREPARE: Direct: Dilute 10–20 mg with 50 mL sterile water for injection (supplied).  Continuous: Further dilute with up to 100 mL D5W, NS, or RL to yield 0.1–0.2 mg/mL.   ADMINISTER: Direct: Give a bolus dose over 30 sec.  Continuous: Give at the required rate.   INCOMPATIBILITIES 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.

Adverse Effects (≥1%)

Body as a Whole: Skeletal muscle weakness, malignant hyperthermia. Respiratory: Respiratory depression.

Interactions

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.

Pharmacokinetics

Onset: <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.

Nursing Implications

Assessment & Drug Effects

• Lab tests: Baseline serum electrolytes, acid–base balance, and kidney & liver functions.
• 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 every 30 min 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 (curare-like) 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 physician if recovery is delayed.
• Note: Recovery time may be delayed in patients with cardiovascular disease, edematous states, and in older adults.

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