Adjunct to general anesthesia 

Nondepolarizing Neuromuscular Blockers include- Pipercuranium, Vecuronium,Doxacuranium, Tobocurane, Mivacuranium,Rocuronium, Cisatracurarium, Atracurarium,Pancuronium

Refer- Pancuronium 

The most frequent adverse drug reaction to nonpolarizing blocking agenst as a class is an extension of the drugs pharmacologic reaction. This may vary from skeletal muscle waekness to profound and prolonged skletal muscle paralysis leading to respiraory insufficiency and apnea.

Vecuronium in doses up to 3 times those needed for clinical relaxation did not produce clinically signifiacnt changes in systolic,diastolic or mean arterial pressure. Inadequate reverasl of neuromuscular blockade is possible.

Manage these adverse reactions by manual or mechanical ventilation until recovery. Little or no increase in blockade or duration of action of vecuronium is noted from use of thiobarburates,narcotic analgesics, nitrous oxide or droperidol.

Hypersensitivity- Htpersensitivity reactions such as bronchospasm, flushing, redness, hypotension, tachycardia and other reactions commonly associated with histamine release are unlikely to occur.

Hypersens to vecuronium

Special precaution:

Severe obesity. Malignant hyperthermia. Electrolye balance disease. Alerted circulation time- Conditions associated with with slower circulation time(cardiovasculardisease) old age and edematous states resulting in increased volume of distribution) may contribute to delay in onset time, therefore do not increase the dosage.

Severe obesity or neuromuscular disease- May pose or airway or ventilarion problems requiring special care before , during after use of vecuronium

Malignant hyperthermia- Many drugs used in anesthetic practice are suspected of being capable of triggering MH. Data are insufficint to esatblish wheher vecuronium is capable of triggering MH.

Electrolyte imbalance - and diseases which lead to electrolyte imbalnce such as adrenal cortical insufficiency, have altered neuromuscular blockade. Depending on the nature of imbalance either enhancement or inhibition may be expected.

Warnings-

Myastenia gravis- in patients who have myastenia gravis or myasthenic (eaton Lambert ) syndrome, small doses of vercuronium may have profound efects. Insuch patients, a peripheral nerve stimulator anduse of a small test dose may be of value in monitoring the response to muscle relaxants.

Long term use- long term IV infusion tosupport mechanical ventilation in ICU has not ben studied sufficiently to support dosage recommendations.

Renal/hepatic function impairment- vacuronium is well tolerated without significant prolongation of neuromuscular blocking efect in patients with renal failure who have been optimally prepared for surgery by dialysis.

Pregnancy- curent data do not permit dosage recommendations in patients with impaired liver function.

Children- infants < 1 year of age but > 7 weeks also tested under halothanne anesthesia are moderately more sensitive to vecuronium on a mg/kg basis thanadults and take about 1-1/2 times to recover.

Indication:

Adjunct to general anesthesia Dosage: For IV use only. Initial dose is 0.08 to 0.1mg/kg as an IV bolus injection. Overdosage- Symptoms Extended skeletal muscle weakness, decreased respiratory reserve, lower tidal volume, prolommged apnea, cardiovascular collapse and sudden release of histamine. sufficiently excessive doses of nondepolarizing muscle relaxants have no antidote.

Treatment

1. A peripheral nerve stimulator may be used to assesss the degree of residual neuromuscular blockade .

2. For residual neuromuscular blockade with respiratory paralysis or inadequate ventilation, maintain airway and administer manual or mechanical ventilation.

Missed dose-

1. If you miss a dose of this medicine, take it as soon as possible.

2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.

3. Do not double doses.

Pharmacology:

Vercuronium bromide, a nondepolarizing neuromuscular blocking agent of intermediate duration, posseses the pharmacologic actions of curariform class. It competes for cholinergic receptors at motor end-plate, and its effects are reversed by acetylcholinesterase inhibitors.

Pharmacokinetics:

Following an initial IV dose, vercuronium produces the first depression of twitch in 1 minute, good intubation conditions within 2.5 to 3 minutes and maximum neuromuscular blockade within 3 to 5 minutes.

Pregnancy:

Use only when clearly needed.

Children-

Available information does not permit recommendations for usage in neonates.