Trade Names:Pancuronium Bromide- Injection 1 mg/mL- Injection 2 mg/mL
Binds competitively to cholinergic receptors on motor end-plate to antagonize action of acetylcholine, resulting in block of neuromuscular transmission.
Vd is 241 to 280 mL/kg. Plasma protein binding is 87%; strong binding to gamma globulin and moderate to albumin.
Hepatic to active 3-hydroxy metabolite, which is half as potent a blocking agent as pancuronium. Other less potent metabolites include 17-hydroxy metabolite and 3,17-dihydroxy metabolite.
Urine (40% as unchanged), bile (11% as metabolites). The t 1/ 2 is 89 to 161 min. Plasma Cl is approximately 1.1 to 1.9 mL/min/kg.
Elimination t ½ doubles, plasma Cl reduces 60%, and Vd may be elevated and variable.Hepatic Function Impairment
In patients with cirrhosis, the Vd increases approximately 50%, plasma Cl decreases 22%, and elimination t ½ doubles.Biliary obstruction
Plasma Cl decreases 50%, Vd increases approximately 50%, and elimination t ½ doubles.
Adjunct to general anesthesia for induction of skeletal muscle relaxation; facilitation of management of patients undergoing mechanical ventilation; facilitation of tracheal intubation.
Individualize dose to each case.Endotracheal IntubationAdults and children older than 1 mo of age
IV bolus 0.06 to 0.1 mg/kg. Skeletal muscle relaxation usually occurs in 2 to 3 min.Newborns younger than 1 mo of age
IV For test dose, use 0.02 mg/kg.Surgical ProceduresAdults and children older than 1 mo of age
IV 0.04 to 0.1 mg/kg initially. For maintenance therapy, use incremental doses q 25 to 60 min beginning with 0.01 mg/kg.Newborns younger than 1 mo of age
IV For test dose, use 0.02 mg/kg.
Store undiluted product in refrigerator (36° to 46°F) to maintain potency for 24 mo, or at controlled room temperature (65° to 72°F) to maintain potency for 6 mo. Diluted solution is stable for 48 h at controlled room temperature.
May augment action of pancuronium.Azathioprine, mercaptopurine
May cause reversal of neuromuscular blocking effects of pancuronium.Carbamazepine, hydantoins
May decrease duration and effect of pancuronium.Halothane/tricyclic antidepressants
Patients receiving chronic TCA therapy who are anesthetized with halothane should use pancuronium with caution; severe ventricular arrhythmias may result.Theophyllines
May cause possible resistance to, or reversal of, effects of pancuronium; cardiac arrhythmias may occur.Trimethaphan
May cause prolonged apnea.
None well documented.
Rise in arterial pressure, cardiac output, and heart rate. Decrease in central venous pressure.
Respiratory insufficiency; apnea.
Skeletal muscle weakness to complete relaxation; hypersensitivity reactions (eg, bronchospasm, flushing, redness, hypotension, tachycardia).
Administer via trained personnel. Have equipped facility available to monitor, assist, and control respiration.
Category C ; do not use in early pregnancy.
Prolonged use in newborns undergoing mechanical ventilation has been associated with severe skeletal muscle weakness and methemoglobinemia. Contains benzyl alcohol, which is related to a fatal gasping syndrome in premature infants.
Reduce dosage in cesarean section if patient is receiving magnesium sulfate.
Renally excreted; may require lower doses or less frequent maintenance doses.Altered circulation time (eg, elderly patients, patients with CV disease or edema)
Delay in onset of action.
Neuromuscular blockade may be altered depending on nature of imbalance.
Results in slower onset and prolonged duration.
Small doses may have profound effects.
Require special attention to airway maintenance and ventilatory support.
Pancuronium does not have analgesic or antianxiety effects. Paralyzed patient will still need analgesic or sedative agents if indicated.
Skeletal muscle relaxation, decreased respiratory reserve, low tidal volume, apnea, prolonged neuromuscular blockade.
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