Vecuronium Bromide

A to Z Drug Facts

Vecuronium Bromide

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(veh-CUE-row-nee-uhm BROE-mide)

Norcuron

Class: Nondepolarizing neuromuscular blocker/muscle relaxant;Anesthetic adjunct

Action Causes paralysis of skeletal muscles by binding competitively to cholinergic receptors on motor end-plate to antagonize action of acetylcholine, resulting in block of neuromuscular transmission.

Indications Adjunct to general anesthesia to facilitate endotracheal intubation and provide skeletal muscle relaxation during surgery or mechanical ventilation.

Contraindications Hypersensitivity to vecuronium or bromides.

Route/Dosage

ADULTS & CHILDREN > 10 YR: IV Initial dose: for inhalation 0.08 to 0.1 mg/kg. Reduce initial dose by 15% (0.06 to 0.85 mg/kg) if inhalation agents are already in use. If intubation is performed using succinylcholine, reduce initial dose to 0.04 to 0.06 mg/kg with inhalation anesthesia and 0.05–0.06 mg/kg with balanced anesthesia. Maintenance: IV bolus 0.01 to 0.015 mg/kg within 25 to 40 min of initial dose, then q 12 to 15 min. IV infusion: 1 mg/kg/min initially beginning 20 to 40 min after IV bolus. Titrate to desired clinical response. CHILDREN 1 TO 10 YR: IV Slightly higher initial doses and more frequent supplementation. INFANTS 7 WK TO 1 YR: IV Slightly lower doses and 1.5 times less frequent.

Interactions

Aminoglycosides, verapamil, inhalation anesthetics (eg, enflurane, isoflurane), lincosamides (eg, clindamycin, lincomycin), magnesium salts, polypeptide antibiotics (eg, bacitracin, polymyxin B): May enhance action of vecuronium (eg, respiratory depression). Hydantoins, carbamazepine: May cause vecuronium to have shorter duration or decreased effectiveness. Quinidine, quinine: Recurrent paralysis may occur with injection of quinidine during recovery from use of other muscle relaxants. Theophyllines: Dose-dependent reversal of neuromuscular blockade is possible. Thiopurines (eg, mercaptopurine): May decrease or reverse vecuronium action. Trimethaphan: May cause prolonged apnea.

Lab Test Interferences None well documented.

Adverse Reactions

RESP: Respiratory insufficiency; apnea. OTHER: Skeletal muscle weakness; profound and prolonged skeletal muscle paralysis.

Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Infants are moderately more sensitive and take longer to recover. Not recommended in neonates; diluent contains benzyl alcohol (fatal-gasping syndrome). Elderly or debilitated patients: May experience delayed onset of action. Circulatory disease (eg, cardiovascular disease, elderly, edematous states): May cause delayed onset of action, do not increase dosage. Consciousness: Vecuronium has no known effect on consciousness, pain threshold, or cerebration. Accompany administration of this drug by adequate anesthesia. Electrolyte imbalance: Neuromuscular blockade may be altered depending on nature of imbalance. Hepatic/renal/biliary disease: Prolonged neuromuscular blockade may occur due to reduced elimination. Higher doses may be needed due to increased volume of distribution. Malignant hyperthermia: Monitor patient closely. Myasthenia gravis: Small doses may have profound effects; administer test dose in monitoring response to muscle relaxants. Severe obesity or neuromuscular disease: May pose airway or ventilation problems requiring special care before, during or after vecuronium.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Administer IV only. Not for IM administration.
Administer only if intubation, artificial respiration, oxygen, and reversal agents are immediately available.
Reconstitute with 0.9% Sodium Chloride, 5% Dextrose, 5% Dextrose in Saline, Lactated Ringer's Solution, or Sterile Water for Injection.
May reconstitute with Bacteriostatic Water for Injection. However, when this diluent is used, solution contains benzyl alcohol and is contraindicated in newborns.
Store unopened vial at room temperature. Protect from light.
Following reconstitution, refrigerate. Use within 8 hr.
Intended for single use only. Discard unused portions.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
In patients with myasthenia gravis, perform test dose.
Observe for histamine-release symptoms, bronchospasm, flushing, redness, hypotension, and tachycardia.
Monitor respirations and be prepared to assist or control respiration.
Monitor BP and pulse.
Assess skeletal muscle tone.
Monitor I & O.
Check for urinary retention.
Monitor carefully for signs of increased or decreased efficacy and pharmacologic activity (eg, muscle twitch response to peripheral nerve stimulation).

OVERDOSAGE: SIGNS & SYMPTOMS
	Skeletal muscle weakness, neuromuscular block beyond time needed, hypotension, decreased respiratory reserve, low tidal volume, apnea

Patient/Family Education

Explain to patient and family that patient will recover from anesthesia in 25 to 40 min.
Inform patient and family that patient may have difficulty speaking when recovering postoperatively but that speech will improve as effects of medication wear off.
Inform patient that postoperative urinary retention is possible.