II. Precautions
- Used only in Anesthesia, emergency and Intensive Care
- Airway and Respiratory Control is critical after use
-
Paralytic Agents do not alter Level of Consciousness
- Must be used with sedation and analgesia
III. Indication
- Paralysis in Rapid Sequence Intubation
- Maintenance of paralysis
-
Neuromuscular Blockade drug of choice
- Except when contraindicated (see below)
IV. Contraindications
- Renal Failure (Creatinine Clearance <10 ml/min)
- Hepatic failure (due to up to 45% hepatic metabolism)
- Unstable cardiovascular status
- Shorter duration of action needed
V. Mechanism
- Non-depolarizing Neuromuscular Blocking Agent
- Structurally similar to Vecuronium
- Same steroid nucleus
- Quaternary Nitrogen at position 2 is only difference
- Significantly different effects than Vecuronium
- Primarily renal excretion (up to 70%)
- Tachycardia due to vagolytic and Sympathomimetic
- Significantly longer duration of action
VI. Dose
- Initial Dose
- Pancuronium alone: 0.06 to 0.1 mg/kg IV
- Pancuronium after Succinylcholine: 0.05 mg/kg IV
- Maintenance dosing (if needed)
- Starts 25-60 minutes after initial dose
- Please see other references for maintenance dosing
- Renal Impairment
- Do not use by intramuscular dosing
VII. Pharmacokinetics
- Onset: 2-3 minutes
- Duration: 40-60 minutes
- Primarily renal excretion (60 to 80%), but may also need dose adjustment in liver disease
VIII. References
- Miller in Katzung (1989) Pharmacology, p. 323-33
- Savarese in Miller (2000) Anesthesia, p. 412-90
- (2003) Lexicomp Drug database for Pocket PC