Vecuronium Bromide (Norcuron)

Anesthesia Implications

Classification: Non-Depolarizing Muscle Relaxant, Monoquaternary aminosteroid
Therapeutic Effects: Paralysis
Time to Onset: 3-5 minutes
Time to Peak: 3-5 minutes
Duration: Intubating dose: 45-90 min. Maintenance: 20-35 minutes. Longer acting in adult females and neonates/infants (immature hepatic system)

Primary Considerations

Vecuronium interferes with a patient’s ability to maintain a normal ventilatory response to an elevated PaCO2. Vecuronium has been reported to markedly enhance bradycardia associated with large doses of opioids, particularly sufentanil.

These will prolong the duration of vecuronium: Atypical Pseudocholinesterase (Plasma Cholinesterase), Volatile Anesthetics (least with Nitrous Oxide), Aminoglycoside antibiotics, Cardiac antidysrhythmic drugs, Diuretics-lasix at 1mg/kg, Local Anesthetics (Amides), HYPOkalemia, Respiratory Acidosis, Hypothermia, Calcium Channel Blockers, Lithium, Immunosuppressants, Renal disease (due to delayed excretion), Hepatic disease (very little effects), Neuromuscular diseases, Anti-neoplastics

Sevoflurane shortens the onset of Vecuronium.

Reversed with sugammadex (2-16 mg/kg) or neostigmine & robinul combination (0.04mg/kg Neostigmine + 0.2mg for every full mg of Neostigmine)

Volatile agents decrease the nondepolarizer dosage requirements.  The degree of the augmentation of blockade depends on the inhalational agent, with desflurane >  sevoflurane  > isoflurane > nitrous oxide.

This drug follows the general rule of dosing hydrophilic drugs – use IDEAL body weight unless obese.  If obese, use LEAN body weight

Neonates: The undeveloped liver combined with active metabolites prolongs the duration of vecuronium in neonates.

IV push dose

Intubating: 0.1 mg/kg (adult and pediatrics patients)
Maintenance: 0.01 mg/kg
Use IDEAL body weight
Obese – use LEAN body weight

Metabolism

Hepatic (very little) & Renal; Active metabolites

Elimination

Biliary (primary) & Renal. Very long elimination half-life (~50-90 minutes in adults)