II. Precautions

  1. Used only in anesthesia, emergency and intensive care
  2. Airway and respiratory control is critical after use
  3. Paralytic Agents do not alter Level of Consciousness
    1. Must be used with Sedation and analgesia

III. Indication

  1. Paralysis in Rapid Sequence Intubation
  2. Maintenance of paralysis
  3. Neuromuscular Blockade drug of choice
    1. Except when contraindicated (see below)

IV. Contraindications

  1. Renal Failure (Creatinine Clearance <10 ml/min)
  2. Hepatic failure (due to up to 45% hepatic metabolism)
  3. Unstable cardiovascular status
  4. Shorter duration of action needed

V. Mechanism

  1. Non-depolarizing Neuromuscular Blocking Agent
  2. Structurally similar to Vecuronium
    1. Same steroid nucleus
    2. Quaternary Nitrogen at position 2 is only difference
  3. Significantly different effects than Vecuronium
    1. Primarily renal excretion (up to 70%)
    2. Tachycardia due to vagolytic and Sympathomimetic
    3. Significantly longer duration of action

VI. Dose

  1. Initial Dose
    1. Pancuronium alone: 0.06 to 0.1 mg/kg IV
    2. Pancuronium after Succinylcholine: 0.05 mg/kg IV
  2. Maintenance dosing (if needed)
    1. Starts 25-60 minutes after initial dose
    2. Please see other references for maintenance dosing
  3. Renal Impairment
    1. Cut dose by 50% if CrCl 10-50 ml/min
    2. Do not use Pancuronium if CrCl <10 ml/min
  4. Do not use by intramuscular dosing

VII. Pharmacokinetics

  1. Onset: 2-3 minutes
  2. Duration: 40-60 minutes

VIII. References

  1. Miller in Katzung (1989) Pharmacology, p. 323-33
  2. Savarese in Miller (2000) Anesthesia, p. 412-90
  3. (2003) Lexicomp Drug database for Pocket PC

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Ontology: Pancuronium (C0030310)

Definition (MSH) A bis-quaternary steroid that is a competitive nicotinic antagonist. As a neuromuscular blocking agent it is more potent than CURARE but has less effect on the circulatory system and on histamine release.
Concepts Pharmacologic Substance (T121) , Steroid (T110)
MSH D010197
SnomedCT 50498003, 350064000, 373738000
LNC LP62277-6, MTHU036236
English Pancuronium, pancuronium, Pancuronium [Chemical/Ingredient], Piperidinium, 1,1'-((2beta,3alpha,5alpha,16beta,17beta)-3,17-bis(acetyloxy)androstane-2,16-diyl)bis(1-methyl-), PANCURONIUM, Pancuronium (product), Pancuronium (substance)
Swedish Pankuron
Czech pankuronium
Finnish Pankuroni
Russian PAVULON, PANKURONII, ПАВУЛОН, ПАНКУРОНИЙ
Japanese パンクロニウム
Croatian PANKURONIJ
Polish Pankuronium
Spanish pancuronio (producto), pancuronio (sustancia), pancuronio, sustancia (sustancia), pancuronio, sustancia, pancuronio, Pancuronio
French Pancuronium
German Pancuronium
Italian Pancuronio
Portuguese Pancurônio

Ontology: Pavulon (C0030715)

Concepts Pharmacologic Substance (T121) , Steroid (T110)
MSH D010197
English pavulon, Pavulon, Organon Brand of Pancuronium Bromide, Organon Teknika Brand of Pancuronium Bromide, Pancuronium Organon