Pancuronium

Uses of Pancuronium - a non depolarising neuromuscular blocker with a long duration of action (1–2 h). It is largely excreted unchanged by the kidneys. It causes a 20% increase in HR and BP. It may be a suitable choice in the hypotensive patient, although the tachycardia induced may not be desirable if the HR is already high, e.g. hypovolaemia, septic shock.

Uses
Patients where prolonged muscle relaxation is desirable, e.g. intractable status asthmaticus

Contraindications
Airway obstruction
To facilitate tracheal intubation in patients at risk of regurgitation
Renal and hepatic failure (prolonged paralysis)
Severe muscle atrophy
Tetanus (sympathomimetic effects)

Administration
• Initial dose: 50–100 μg/kg IV bolus
• Incremental doses: 20 μg/kg, every 1–2 h
Monitor with peripheral nerve stimulator

How not to use pancuronium
As part of a rapid sequence induction In the conscious patient By persons not trained to intubate trachea

Adverse effects
Tachycardia and hypertension
Prolonged use (disuse muscle atrophy)

Cautions
Breathing circuit (disconnection)
Prolonged use (disuse muscle atrophy)

Organ failure
Hepatic: prolonged paralysis
Renal: prolonged paralysis

Renal replacement therapy
No further dose modification is required during renal replacement therapy